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Characterization of neuroinflammation pattern in anti-LGI1 encephalitis based on TSPO PET and symptom clustering analysis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

TSPO PET with radioligand [18F]DPA-714 is an emerging molecular imaging technique that reflects cerebral inflammation and microglial activation, and it has been recently used in central nervous system diseases. In this study, we aimed to investigate the neuroinflammation pattern of anti-leucine-rich glioma-inactivated 1 (LGI1) protein autoimmune encephalitis (AIE) and to evaluate its possible correlation with clinical phenotypes.

Methods

Twenty patients with anti-LGI1 encephalitis from the autoimmune encephalitis cohort in Huashan Hospital and ten with other AIE and non-inflammatory diseases that underwent TSPO PET imaging were included in the current study. Increased regional [18F]DPA-714 retention in anti-LGI1 encephalitis was detected on a voxel basis using statistic parametric mapping analysis. Multiple correspondence analysis and hierarchical clustering were conducted for discriminate subgroups in anti-LGI1 encephalitis. Standardized uptake value ratios normalized to the cerebellum (SUVRc) were calculated for semiquantitative analysis of TSPO PET features between different LGI1-AIE subgroups.

Results

Increased regional retention of [18F]DPA-714 was identified in the bilateral hippocampus, caudate nucleus, and frontal cortex in LGI1-AIE patients. Two subgroups of LGI1-AIE patients were distinguished based on the top seven common symptoms. Patients in cluster 1 had a high frequency of facio-brachial dystonic seizures than those in cluster 2 (p = 0.004), whereas patients in cluster 2 had a higher frequency of general tonic–clonic (GTC) seizures than those in cluster 1 (p < 0.001). Supplementary motor area and superior frontal gyrus showed higher [18F]DPA-714 retention in cluster 2 patients compared with those in cluster 1 (p = 0.024; p = 0.04, respectively).

Conclusions

Anti-LGI1 encephalitis had a distinctive molecular imaging pattern presented by TSPO PET scan. LGI1-AIE patients with higher retention of [18F]DPA-714 in the frontal cortex were more prone to present with GTC seizures. Further studies are required for verifying its value in clinical application.

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Data Availability

All research data supporting this publication are directly available within this publication.

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Funding

This study was supported by the Clinical Research Plan of SHDC (SHDC2020CR2027B), National and Provincial Multi-disciplinary Cooperation in Diagnosis and Treatment of Major Diseases Capacity Improvement Project (Shanghai Municipal Health Commission); grants from the National Natural Science Foundation of China (81971641); Research project of Shanghai Health Commission (2020YJZX0111); Clinical Research Plan of SHDC (SHDC2020CR1038B); and Medical Innovation Research Project of Shanghai Science and Technology Commission (21Y11903300).

Author information

Author notes

  1. Jingguo Wang and Jingjie Ge contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China

    Jingguo Wang, Lei Jin, Bo Deng, Hai Yu, Xiang Zhang, Xiaoni Liu & Xiangjun Chen

  2. National Center for Neurological Disorders, 12 Wulumuqi Zhong Road, Shanghai, 200040, China

    Jingguo Wang, Lei Jin, Bo Deng, Hai Yu, Xiang Zhang, Xiaoni Liu & Xiangjun Chen

  3. Department of Nuclear Medicine/PET Center, Huashan Hospital, Fudan University, 518 East Wuzhong Road, Shanghai, 200235, China

    Jingjie Ge & Chuantao Zuo

  4. Department of Radiology, Huashan Hospital, Shanghai, 200040, China

    Weijun Tang

  5. Department of Nuclear Medicine, the Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China

    Le Xue

  6. Human Phenome Institute, Fudan University, Shanghai, China

    Xiangjun Chen

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  1. Jingguo Wang
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Contributions

Jingguo Wang: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. Jingjie Ge: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. Lei Jin: major role in the acquisition of data; analysis or interpretation of data. Bo Deng: major role in the acquisition of data; analysis or interpretation of data. Weijun Tang: major role in the acquisition of data. Hai Yu: major role in the acquisition of data. Xiang Zhang: major role in the acquisition of data. Xiaoni Liu: major role in the acquisition of data. Chuantao Zuo: major role in the acquisition of data; study concept or design. Xiangjun Chen: drafting/revision of the manuscript for content; major role in the acquisition of data; study concept or design.

Corresponding authors

Correspondence to Chuantao Zuo or Xiangjun Chen.

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This study protocol was approved by the institutional review board of Huashan Hospital, Fudan University.

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Written informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Fig. 1a.

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Wang, J., Ge, J., Jin, L. et al. Characterization of neuroinflammation pattern in anti-LGI1 encephalitis based on TSPO PET and symptom clustering analysis. Eur J Nucl Med Mol Imaging 50, 2394–2408 (2023). https://doi.org/10.1007/s00259-023-06190-8

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  • DOI: https://doi.org/10.1007/s00259-023-06190-8

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