18F-Flurodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) findings in children with encephalitis and comparison to conventional imaging

  • Sophie TurpinEmail author
  • Patrick Martineau
  • Marc-André Levasseur
  • Inge Meijer
  • Jean-Claude Décarie
  • Julie Barsalou
  • Christian Renaud
  • Hélène Decaluwe
  • Elie Haddad
  • Raymond Lambert
Original Article



FDG PET/CT is emerging as a new tool for the evaluation of acute encephalitis (AE). However, to date, there are no exclusively pediatric studies on the use of FDG PET for suspected AE. The objective of this study was to compare qualitative and quantitative brain PET to conventional brain imaging in a cohort of children, and to identify patterns of metabolic abnormalities characteristic of AE.


This retrospective study included 34 children imaged with PET/CT, CT and magnetic resonance imaging (MRI). The positivity rate of all three imaging modalities was measured. Besides visual assessment, quantification of relative regional brain metabolism (RRBM) was performed and compared to a database of normal pediatric brains.


Fourteen subjects had a clinical diagnosis of autoimmune encephalitis (AIE) or encephalitis of unknown origin (EX), six of anti-N-methyl-D-aspartate receptor (anti-NMDAr) encephalitis, three of Hashimoto’s encephalopathy, three of neurolupus and eight had other subtypes of encephalitis.

Quantitative PET was abnormal in 100% of cases, visually assessed PET in 94.1% of subjects, MRI in 41.2% and CT in 6.9%. RRBM quantification demonstrated multiple hyper and hypo metabolic cortical regions in 82.3% of subjects, exclusively hypermetabolic abnormalities in 3%, and exclusively hypometabolic abnormalities in 14.7%. The basal ganglia were hypermetabolic in 26.5% of cases on visual assessment and in 58.8% of subjects using quantification.


In our pediatric population FDG PET was more sensitive than conventional imaging for the detection of AE, and basal ganglia hypermetabolism was frequently encountered.


Fluorodeoxyglucose Positron emission tomography Computed tomography Magnetic resonance imaging Children Encephalitis 



Dr. Daniel H Silverman, UCLA Medical Center.


This study was funded from a financial support from the Radiology, Radio-oncology and Nuclear Medicine Department, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada, “10th Faculty Competition”, 2016.

Compliance with ethical standards

Ethical approval

The study was approved by the ethical committee of our institution.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bloch KC, Glaser CA. Encephalitis surveillance through the emerging infections program, 1997-2010. Emerg Infect Dis. 2015;21:1562–7.CrossRefGoogle Scholar
  2. 2.
    Falchek SJ. Encephalitis in the pediatric population. Pediatr Rev. 2012;33:122–33.CrossRefGoogle Scholar
  3. 3.
    Dale RC, Gorma MP, Lim M. Autoimmune encephalitis in children: clinical phenomenology, therapeutics and emerging challenges. Curr Opin Neurol. 2017;30:334–44.CrossRefGoogle Scholar
  4. 4.
    Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Celluci T, et al. A clinical approach for the diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15:391–404.CrossRefGoogle Scholar
  5. 5.
    Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar B, et al. Case definitions, diagnosis algorithms and priorities: consensus statement of the international encephalitis consortium. Clin Infect Dis. 2013;57:1114–28.CrossRefGoogle Scholar
  6. 6.
    Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, et al. Beyond viruses: clinical profiles and etiologies with encephalitis. Clin Infect Dis. 2006;43:1565–57.CrossRefGoogle Scholar
  7. 7.
    He T, Kaplan S, Kamboj M, Tang YW. Laboratory diagnosis of central nervous system infection. Curr Infect Dis Rep. 2016;18:35–47.CrossRefGoogle Scholar
  8. 8.
    Sominer FE. Autoimmune encephalitis: history and current knowledge. Copenhagen: Statens Serum Institut; 2016. Version 5.8.Google Scholar
  9. 9.
    Morbelli S, Booij J, Chen MK, Chetelat G, Cross DJ, Djekidel M, et al. On behalf of the EANM and SNMMI. The need for standardization and of large clinical studies in an emerging indication of 18F- FDG: the auto-immune encephalitis. Eur J Nucl Med Mol Imaging. 2017;44:353–7.Google Scholar
  10. 10.
    Turpin S, Martineau PJ, Levasseur MA, Lambert R. Modeling the effects of age and gender on normal pediatric brain metabolism using 18F-FDG PET/CT. J Nucl Med. 2018;59:1118–24.CrossRefGoogle Scholar
  11. 11.
    Melzer N, Meuth SG, Wiendl H. Paraneoplastic and non-paraneoplastic autoimmunity to neurons in the central nervous system. J Neurol. 2013;260:1215–33.CrossRefGoogle Scholar
  12. 12.
    Dalmau J, Geis C, Graus F. Autoantibodies to synaptic receptors and neuronal cell surface proteins in autoimmune disease of the central nervous system. Physiol Rev. 2017;97:839–87.CrossRefGoogle Scholar
  13. 13.
    Pignolet BSL, Gebauer CMT, Liblau RS. Immunopathogenesis of paraneoplastic neurological syndromes associated with anti-Hu antibodies. A beneficial antitumor immune response going awry. OncoImmunology. 2013;2:e27384. (1–10).Google Scholar
  14. 14.
    Gable MS, Sherriff H, Dalmau J, Tilleu DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California encephalitis project. Clin Infect Dis. 2012;54:899–904.CrossRefGoogle Scholar
  15. 15.
    Erlich DJ, Walker EH. Functional neuroimaging and chorea: a systematic review. J Clin Mov Disord. 2017;4:8–27.CrossRefGoogle Scholar
  16. 16.
    Delle AcqueGiogio SM, Caprio MG, Galante F, Russo G, Romano A, Vergara E, et al. Clinical value of perfusion abnormalities of brain on Technitium-9m HMPAO single photon emission computed tomography in children with Sydenham chorea. J Child Neurol. 2017;32:316–21.Google Scholar
  17. 17.
    Ho L. Hypermetabolism in bilateral basal ganglia in Sydenham chorea on 18F-FDG PET/CT. Clin Nucl Med. 2009;34:114–6.CrossRefGoogle Scholar
  18. 18.
    Baumgartner A, Rauer S, Mader I, Meyer PT. Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis: correlation with autoantibody types. J Neurol. 2013;260:2744–53.CrossRefGoogle Scholar
  19. 19.
    Solnes LB, Jones KM, Rowe SP, Pattanayak P, Nalluri A, Venkatesan A, et al. Diagnostic value of 18F-FDG PET/CT versus MRI in the setting of antibody-specific autoimmune encephalitis. J Nucl Med. 2017;58:1307–13.CrossRefGoogle Scholar
  20. 20.
    Tripathi M, Tripathi M, Roy SG, Parida GK, Ihtisham K, Dash D, et al. Metabolic topography of autoimmune non-paraneoplastic encephalitis. Neuroradiology. 2018;60:189–98.CrossRefGoogle Scholar
  21. 21.
    Lagarde S, Lepine A, Caietta E, Pelletier F, Boucrot J, Chabrol B, et al. Cerebral 18 FluoroDeoxyglucose positron emission tomography in paediatric anti N-Metyl-D-aspartate receptor encephalitis: a case series. Brain and Development. 2016;38:461–70.CrossRefGoogle Scholar
  22. 22.
    Probasco JC, Solnes L, Nalluri A, Cohen J, Jones KM, Zan E, et al. Decreased occipital lobe metabolism by FDG PET/CT: an anti-NMDA receptor encephalitis biomarker. Neurol Neuroimmunol Neuroinflamm. 2018;5:e413–9.CrossRefGoogle Scholar
  23. 23.
    Leypoldt F, Buchert R, Kleiter I, Mariehagen J, Gelderblom M, Magnus T, et al. Fluorodeoxyglucose positron emission tomography in anti-Nmethyl-D-aspartate receptor encephalitis; distinct pattern of disease. J Neurol Neurosurg Psychiatry. 2012;83:681–6.CrossRefGoogle Scholar
  24. 24.
    Yuan J, Guan H, Zhou X, Niu N, Li F, Cui L, et al. Changing brain metabolism patterns in subjects with ANMDARE: serial 18F-FDG PET/CT findings. Clin Nucl Med. 2016;41:1–5.CrossRefGoogle Scholar
  25. 25.
    Pillai SC, Gill D, Webster R, Howman-Giles R, Dale RC. Cortical hypometabolism demonstrated by PET in relapsing NMDA receptor encephalitis. Pediatr Neurol. 2010;43:218–20.CrossRefGoogle Scholar
  26. 26.
    Probasco JC, Solnes L, Nalluri A, Cohen J, Jones KM, Zan E, et al. Abnormal brain metabolism on FDG-PET/CTis a common early finding in autoimmune encephalitis. Neurol Neuroimmunol Neuroinflamm. 2017;4:e352. (1–10).
  27. 27.
    Strauss J, Franzius C, Pfluger T, Juergens KU, Biassoni L, Begent J, et al. Guidelines for 18F-FDG PET and PET-CT imaging in paediatric oncology. Eur J Nucl Med Mol Imaging. 2008;35:1581–8.CrossRefGoogle Scholar
  28. 28.
    Weiner SM, Otte A, Schumacher M, Klein R, Gutfleisch J, Brink I, et al. Diagnosis and monitoring of central nervous system involvement in systemic lupus erythematosus: value of 18F-Fluorodeoxyglucose PET. Ann Rheum Dis. 2000;59:377–85.CrossRefGoogle Scholar
  29. 29.
    Lee SW, Park MC, Lee SK, Park YB. The efficacy of brain 18F-fluorodeoxyglucose positron emission tomography in neuropsychiatric lupus subjects with normal brain magnetic resonance imaging findings. Lupus. 2012;21:1531–7.CrossRefGoogle Scholar
  30. 30.
    Nowak M, Carrasquillo JA, Yarboro CH, Bacharach SL, Whatley M, et al. A pilot study of the use of FDG PET to assess the distribution of activated lymphocytes in subjects with SLE. Arthritis Rheum. 2004;50:1233–8.CrossRefGoogle Scholar
  31. 31.
    Pari E, Rinaldi F, Premi E, Codella M, Renata R, Paghera B, et al. A follow-up 18F-FDG brain PET study in a case of Hashimoto's encephalopathy causing drug-resistant status-epileptic treated with plasmapheresis. J Neurol. 2014;261:663–7.CrossRefGoogle Scholar
  32. 32.
    Bartlett EJ, Brodie JD, Simkowitz P, Dewey SL, Rusinek H, Wolf AP, et al. Effects of haloperidol challenge in regional glucose utilization in normal human subjects. Am J Psychiatry. 1994;151:681–8.CrossRefGoogle Scholar
  33. 33.
    Wang GJ, Volkow ND, Fowler JS, Hitzemann RJ, Pappas NR, Netuzil N. Evaluation of gender differences in regional brain metabolic responses to lorazepam. Psychiatry Res (Neuro). 1998;82:37–47.CrossRefGoogle Scholar
  34. 34.
    Laaksonen L, Kallioinene M, Långsjö J, Laitio T, Scheinin A, Scheinin J, et al. Comparative effects of dexmedetomidine, propofol, sevoflurane, and S-ketamine on the regional cerebral glucose metabolism in humans: a positron emission tomography study. Br J Anaesth. 2018;121:281–90.CrossRefGoogle Scholar
  35. 35.
    Zhu Y, Feng J, Wu S, Hou H, Ji J, Zhang K, et al. Glucose metabolic profile by visual assessment combined with statistical parametric mapping analysis in pediatric patients with epilepsy. J Nucl Med. 2017;58:1293–9.CrossRefGoogle Scholar
  36. 36.
    De Blasi B, Barnes A, Galazzo IB, Hua CH, Shulkin B, Koepp M, et al. Age-specific 18F-FDG image processing pipelines and analysis are essential for individual mapping of seizure foci in paediatric patient with intractable epilepsy. J Nucl Med. 2018;59:1590–6.Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sophie Turpin
    • 1
    Email author
  • Patrick Martineau
    • 2
  • Marc-André Levasseur
    • 3
  • Inge Meijer
    • 4
  • Jean-Claude Décarie
    • 5
  • Julie Barsalou
    • 6
  • Christian Renaud
    • 7
  • Hélène Decaluwe
    • 6
  • Elie Haddad
    • 6
  • Raymond Lambert
    • 1
  1. 1.Division of Nuclear Medicine, Department of Medical ImagingCentre Hospitalier Universitaire Sainte-JustineMontréalCanada
  2. 2.Department of Nuclear Medicine, Health Sciences CentreUniversity of ManitobaWinnipegCanada
  3. 3.Department of Nuclear MedicineCentre Hospitalier Universitaire de SherbrookeSherbrookeCanada
  4. 4.Division of Neurology, Department of PediatricsCentre Hospitalier Universitaire Sainte-JustineMontréalCanada
  5. 5.Department of Medical ImagingCentre Hospitalier Universitaire Sainte-JustineMontréalCanada
  6. 6.Division of Immunology, Allergy, Rhumatology, Department of PediatricsCentre Hospitalier Universitaire Sainte-JustineMontréalCanada
  7. 7.Division of Microbiology, Infectious Disease, Department of PediatricsCentre Hospitalier Universitaire Sainte-JustineMontréalCanada

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