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FDG–PET in patients with autoimmune encephalitis: a review of findings and new perspectives

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A Correction to this article was published on 28 August 2023

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Abstract

Purpose

The present review aims to discuss the role of the brain 18F-FDG–PET and 18F-FDG–PET/CT (FDG–PET) in diagnosis and follow-up of the autoimmune encephalitis (AE) patients, highlighting the main findings and the new perspectives on use of these methods in the study of the disease.

Methods

The literature search was performed in the following databases: PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar, according to the PRISMA statement. The main terms of search were: “autoimmune encephalitis” AND “18F-FDG–PET OR 18F-FDG–PET/CT”, or the combination between the term “18F-FDG–PET” OR “18F-FDG–PET/CT” AND the antibodies receptors abbreviations (e.g., “NMDA”, “VGKC”, etc.). The methodological quality of the publications was assessed according to the QUADAS-2 criteria.

Results

The search of the articles found 56 main articles. These articles encompassed 1,462 patients with AE positive antibodies, from which 808 had brain FDG–PET images with 714 (88.67%) showing alterations. Furthermore, some AE antibodies have specific metabolic signatures, detected in the images, which are discussed in the text. Moreover, patients at different stages of the disease may present different brain metabolic patterns. The areas of more common hypermetabolism were basal ganglia, hippocampus, amygdala, and cerebellum. The areas of more common hypometabolism were the visual cortex and a diffuse cortical metabolism.

Conclusions

This extensive literature review shows the high sensitivity of FDG–PET and FDG–PET/CT in patients with AE. FDG–PET detects findings of hyper and hypometabolism which are suggestive of AE. Besides, AE caused by the different antibodies may present specific alterations which may be suggestive of each one. However, more prospective studies are necessary for these images become a standard diagnostic method of AE.

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Acknowledgements

The authors would like to thank the whole team of the Nuclear Medicine Division of the Clinical Hospital—UNICAMP, the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), and the Department of Neurology—Campinas Medical School – UNICAMP.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Anesthesiology, Oncology and Radiology (DAOR), School of Medical Sciences, State University of Campinas (UNICAMP), Avenue Zeferino Vaz, S/N, PO Box 6149, Campinas, SP, 13080 000, Brazil

    Maurício Martins Baldissin, Elba C. S. C. Etchebehere & Bárbara Juarez Amorim

  2. Surgery Department, Jundiaí Medical School, Neurodiagnosis and Neurotherapy Clinic, Barão de Teffé St, 160, Office 405, 4th Floor, Jundiaí, SP, 13208 760, Brazil

    Maurício Martins Baldissin

  3. Cancer Theranostics Innovation Center (CancerThera), University of Campinas (UNICAMP), Campinas, Brazil

    Maurício Martins Baldissin, Edna Marina de Souza, Elba C. S. C. Etchebehere & Bárbara Juarez Amorim

  4. Nuclear Medicine Group, Biomedical Engineering Center, Nuclear Medicine Division, State University of Campinas (UNICAMP), 163 Alexander Fleming St, University City, Campinas, SP, 13083 881, Brazil

    Edna Marina de Souza

  5. Department of Neurology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil

    Nancy Watanabe & Fernando Cendes

  6. Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas (UNICAMP), Campinas, Brazil

    Maurício Martins Baldissin, Edna Marina de Souza, Nancy Watanabe & Fernando Cendes

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Literature search and review, manuscript writing, meta-analysis and content planning, manuscript writing and editing (journal suggestion): BS, AE. Study conception and design: BS, AW. Acquisition of data: BSW. Analysis and interpretation of data: BS. Drafting of manuscript: BS, AE. Critical revision: EAC. Approval of the final version: BS, AWE, Cendes.

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Correspondence to Maurício Martins Baldissin.

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Baldissin, M.M., de Souza, E.M., Watanabe, N. et al. FDG–PET in patients with autoimmune encephalitis: a review of findings and new perspectives. Clin Transl Imaging 12, 15–30 (2024). https://doi.org/10.1007/s40336-023-00581-5

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