Wang Yuliang, Zhou Qin, Dai Zhaojun, Qiu Yingwei, Zhou Hongyan, Feng Li, Zhao Jing
Department of Radiology, Shenzhen Nanshan People's Hospital (NSPH), Shenzhen, China,
Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Eur Neurol. 2025;88(2):71-81. doi: 10.1159/000546521. Epub 2025 Jul 11.
The aim of this study was to investigate the diagnostic utility of brain Magnetic resonance imaging (MRI) in anti-N-methyl-
A retrospective analysis was conducted on forty-six (59% female, median age: 24.5 years) clinically identified anti-NMDAR encephalitis patients from December 2012 to April 2022. All the patients underwent multiparametric MRI, with thirteen returning for follow-up. All the relevant clinical information was collected. The initial and follow-up brain MRI was sequentially analyzed for signal abnormalities, involvement of anatomy and structure, and brain/structure atrophy by two experienced neuroradiologists. Additionally, the relationship between clinical and brain MRI features and prognosis was examined.
The most common symptom (33/46, 72%) in anti-NMDAR encephalitis was aberrant psychiatric behavior. Five (10%) cases combined with other positive antibodies. Although 91% of patients with mRS >2 before treatment, a statistically significant decrease mRS were observed after treatment (mRS: 3.50 ± 0.94 vs. mRS: 1.91 ± 1.53, p < 0.001). More than half of the patients had abnormal MRI findings. T2-weighted fluid-attenuated inversion recovery (FLAIR) hyperintense lesions that involve the frontal lobe and the limbic system are the characteristic imaging predilection of anti-NMDAR encephalitis. On follow-up MRI, we noticed 5 patients with significant hippocampal atrophy. Further analysis showed that the hippocampal involvement was a significant factor in predicting worse mRS scores both before and after treatment (p < 0.05).
T2-FLAIR hyperintense lesions in the frontal lobe and the limbic system are indicative of anti-NMDAR encephalitis. The involvement of the hippocampus is a risk factor for a poor prognosis.
本研究旨在探讨脑磁共振成像（MRI）在抗N-甲基-D-天冬氨酸受体脑炎（抗NMDAR脑炎）中的诊断效用，并分析临床与脑MRI特征及疾病预后之间的关系。
对2012年12月至2022年4月临床确诊的46例（女性占59%，中位年龄：24.5岁）抗NMDAR脑炎患者进行回顾性分析。所有患者均接受多参数MRI检查，其中13例进行了随访。收集了所有相关临床信息。由两名经验丰富的神经放射科医生对初始及随访脑MRI依次进行信号异常、解剖结构受累及脑/结构萎缩情况分析。此外，还研究了临床与脑MRI特征及预后之间的关系。
抗NMDAR脑炎最常见的症状（33/46，72%）是异常精神行为。5例（10%）合并其他阳性抗体。尽管治疗前改良Rankin量表（mRS）评分>2的患者占91%，但治疗后mRS评分有统计学意义的下降（mRS：3.50±0.94 vs. mRS：1.91±1.53，p<0.001）。超过半数患者MRI检查结果异常。累及额叶和边缘系统的T2加权液体衰减反转恢复（FLAIR）高信号病变是抗NMDAR脑炎的特征性影像偏好。在随访MRI中，我们注意到5例患者有明显的海马萎缩。进一步分析表明，海马受累是治疗前后mRS评分较差的一个重要预测因素（p<0.05）。
额叶和边缘系统的T2-FLAIR高信号病变提示抗NMDAR脑炎。海马受累是预后不良的危险因素。
