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Two Different 18F-FDG Brain PET Metabolic Patterns in Autoimmune Limbic Encephalitis.
MedLine Citation:
PMID:  22889795     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE: Autoimmune limbic encephalitis (ALE) is a severe, but treatable, neuropsychiatric disorder that is difficult to diagnose clinically. With the goal of improving diagnosis of this disorder, we retrospectively evaluated the cerebral FDG PET pattern in a group of patients with ALE.
MATERIALS AND METHODS: Nine adult patients with subacute cognitive decline were eventually diagnosed with ALE based on clinical presentation, cerebrospinal fluid inflammatory markers, and response to immunosuppressive therapy. All patients received FDG PET brain scanning during their diagnostic evaluation, which were retrospectively reviewed for this study.
RESULTS: Our patients' scans fell into 2 readily separable patterns. Five younger patients had a mixed metabolic pattern most easily recognized by pronounced occipital hypometabolism, accentuated by hypermetabolism in the temporal and orbitofrontal cortex. Other, milder findings were also present. Once this unusual pattern was established as corresponding to ALE, it helped lead to the correct clinical diagnosis in the last 2 patients. Four older patients had scans that closely resembled diffuse neurodegenerative disease.
CONCLUSIONS: We found 2 different PET scan patterns in patients with ALE. One is an easily recognizable mixture of hyper- and hypometabolism that has also been described in a few recent case reports and is potentially specific for ALE. The other is indistinguishable from neurodegenerative disease. We propose that awareness of these patterns may contribute to the diagnosis of this elusive, but treatable, neurologic disorder.
Authors:
Ronald E Fisher; Niraj R Patel; Eugene C Lai; Paul E Schulz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical nuclear medicine     Volume:  37     ISSN:  1536-0229     ISO Abbreviation:  Clin Nucl Med     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7611109     Medline TA:  Clin Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e213-8     Citation Subset:  IM    
Affiliation:
From the *Department of Radiology, The Methodist Hospital and Baylor College of Medicine, Houston, TX; †Division of Nuclear Medicine (Department of Radiology), Baylor College of Medicine, Houston, TX; ‡The Methodist Neurologic Institute, The Methodist Hospital, Houston, TX; and §The University of Texas Health Science Center in Houston, The Mischer Neuroscience Institute, and The Memorial Hermann Hospital-TMC, Houston, TX.
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