Article Figures & Data
Figures
- Figure 1 Regional [18F]FDG-PET Findings in LGI1- and Non–LGI1 AE Groups, Alzheimer Disease Group, and NCs
Metabolic activity in (A) putamen and (B) MTL, measured as standardized uptake value ratios (SUVR) normalized to global brain, thalamus and midbrain. (C) Visualization of metabolic abnormalities in individual patients in LGI1-AE and non–LGI1-AE groups using parametric, global normalized [18F]FDG SUVR images. The images represent patients with LGI1-AE (case 6), NMDAr (case 16), and APS-associated (case 25) autoimmune encephalitides (AE) and demonstrate putaminal hypermetabolism and relative occipital hypermetabolism in LGI1-AE, lateral occipital hypometabolism and normal putaminal metabolism in NMDAr-AE, and pronounced putaminal hypermetabolism in APS-AE. Numbering of the patient cases refers to the case numbers in Tables 1 and 2. *p < 0.05 and **p < 0.01 (significant at the level of p < 0.05). [18F]FDG = [18F]fluorodeoxyglucose; AD = Alzheimer disease; AE = autoimmune encephalitis; APS = antiphospholipid syndrome; LGI1 = leucine-rich, glioma–inactivated-1; Mi = midbrain; MTL = mediotemporal lobe; NC = negative control; Non-LGI1 = non-LGI1 autoimmune encephalitis; P = putamen; SUV = standardized uptake value; SUVRg = global brain normalized standardized uptake value ratio; Th = thalamus.
- Figure 2 Diagnostic Accuracy of Putaminal-[18F]FDG Indices and Relationship of Mediotemporal and Putaminal Dysmetabolism With mRS in LGI1-AE
(A.a–c) Receiver operating characteristic (ROC) curve analyses of [18F]FDG putaminal indices for the evaluation of their accuracy in differentiating patients with LGI1-AE from NCs (A.a), non–LGI1-AE group (A.b) and AD group (A.c). All p values are significant at the level of p < 0.05. (B) Comparison of mediotemporal and putaminal metabolic activity, measured as global brain normalized standardized uptake value ratios (SUVRg) of [18F]FDG, in LGI1-AE group with mild-to-moderate disability (mRS ≤ 3) vs moderately severe-to-severe disability (mRS > 3) at the time of the initial [18F]FDG-PET. *p < 0.05 (significant at the level of p < 0.05). [18F]FDG = [18F]fluorodeoxyglucose; AD = Alzheimer disease; AE = autoimmune encephalitis; AUC = area under the curve; LGI1 = leucine-rich, glioma–inactivated-1; Mi = midbrain; mRS = modified Rankin scale; MTL = mediotemporal lobe; NCs = negative controls; non-LGI1 = non-LGI1 autoimmune encephalitis; P = putamen; SUVRg = global brain normalized SUV ratio; Th = thalamus.
- Figure 3 Cortical and Subcortical Dysmetabolism Beyond Putamen and Mediotemporal Lobe in LGI1-AE
Comparison of brain metabolism in patients with LGI1-AE (n = 13) and NCs (n = 10) in (A) cortical and (B) subcortical regions of interest. *p < 0.05, **p < 0.01 (significant at the level of p < 0.05). [18F]FDG = [18F]fluorodeoxyglucose; AE = autoimmune encephalitis; Frontal Inf Oper = opercular part of inferior frontal gyrus; Frontal Inf Orb = orbital part of inferior frontal gyrus; Frontal Inf Tri = triangular part of inferior frontal gyrus; Frontal Med Orb = medial orbital part of superior frontal gyrus; LGI1 = leucine-rich, glioma–inactivated-1; NC = negative controls; occipital Inf; inferior occipital lobe; parietal Inf = inferior parietal lobe; SUVRg = global normalized standardized uptake value ratio.
- Figure 4 Longitudinal Changes in Brain Metabolism After Immunosuppressive Treatment in Patients With LGI1-AE
(A) Individual and group-level changes in brain metabolism from baseline to short-term follow-up in LGI1-AE group (n = 8), measured with [18F]FDG PET indices in mediotemporal lobe and putamen and compared with NCs (n = 10). (B) Visualization of individual changes in brain metabolism after immunotherapy in 2 patients with LGI1-AE using parametric [18F]FDG SUVRg images. The images in (B) demonstrate decreases of the initial hypermetabolism in striatum (case 6) and mediotemporal lobe (case 5) and increases in occipital metabolism (both cases). The numbering of the LGI1 cases refers to the case numbers in Table 1. *p < 0.05, **p < 0.01 (both significant at the level of p < 0.05), #p = 0.05 (significant at the level of p = 0.05). [18F]FDG = [18F]fluorodeoxyglucose; AE = autoimmune encephalitis; LGI1 = leucine-rich, glioma–inactivated-1; Mi = midbrain; MTL = mediotemporal lobe; NC = negative control; P = Putamen; SUV = standardized uptake value; SUVRg = global brain normalized standardized uptake value ratio; Th = thalamus.
- Figure 5 Associations of Cortical Metabolic Abnormalities With Longitudinal Clinical Outcomes in LGI1-AE
(A.a–b) Changes in brain metabolism from baseline to short-term follow-up in LGI1-AE group with no significant disability (mRS < 2, n = 3) (A.a) and with moderate disability (mRS > 2, n = 3) (A.b) as the short-term clinical outcome at the time of follow-up [18F]FDG PET. Results from the statistical parametric mapping (SPM) analyses of voxel-wise [18F]FDG SUVRg images are visualized with T scores, with only voxels with significant within-group changes (threshold of T = 2.92 corresponding to uncorrected p < 0.05) shown, as denoted by the color scale bar. Voxels with significant increases are shown for the mRS < 2 group, and voxels with significant decreases are shown for the mRS > 2 group. (B) Differences in baseline brain metabolism in LGI1-AE group with good (mRS ≤ 2) vs poor (mRS > 2) long-term clinical outcome, visualized with voxel-level analysis of parametric [18F]FDG SUVRg images with SPM. The color scale bar represents voxel-level T scores, and only voxels with significant differences between groups (threshold of T = 2.76 corresponding to uncorrected p < 0.01) are shown. (C) Differences in the time from symptom onset to the initial [18F]FDG-PET between LGI1-AE group with good (mRS ≤ 2) or poor (mRS > 2) long-term clinical outcome. [18F]FDG = [18F]fluorodeoxyglucose; AE = autoimmune encephalitis; Cingulum Post = posterior cingulum; LGI1 = leucine-rich, glioma-inactivated-1; Occipital Inf = inferior occipital; Parietal Sup = superior parietal; SUVRg = global brain normalized standardized uptake value ratio.
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