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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Caspr2 antibody-associated limbic encephalitis: contribution of visual aided ana...
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Vol. 39. Issue 2.
Pages 92-95 (March - April 2020)
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Vol. 39. Issue 2.
Pages 92-95 (March - April 2020)
Caspr2 antibody-associated limbic encephalitis: contribution of visual aided analysis of 18F-FDG PET images using normal database comparison
Encefalitis límbica asociada a anti-Caspr2: contribución del análisis visual ayudado de las imágenes PET con
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Liset Sánchez-Ordúza,c, Gállego Pérez-Larrayab, Fabiana Grisantic, M. Centenob, Javier Arbizuc,
Corresponding author
jarbizu@unav.es

Corresponding author at: Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Avenida de Pío XII, 36. 31008, Pamplona, Spain.
a SPECT Medicina Nuclear S.A.S, UNAB, Bucaramanga, Colombia
b Departamento de Neurología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
c Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
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Table 1. Characteristics of FDG-PET studies in patients with limbic encephalitis with positive anti-Caspr2 antibodies published in the literature.
Abstract

Early immunotherapy is of paramount importance for a positive outcome in patients suffering acute encephalitis of autoimmune origin (AIE). A new approach for early diagnosis based on clinical presentation and complementary tests has been proposed, but not all these tests may exhibit positive findings in the first weeks. While common forms of AIE (anti-LGI-1 and anti-NMDAR antibodies) exhibit consistent 18Fluor-fluorodeoxiglucose (FDG-PET) patterns in many cases, the anti-Caspr2 form of AIE is infrequent and FDG-PET patterns have not been well characterized. In our experience, FDG-PET in anti-Caspr2 limbic encephalitis shows medial temporal hypermetabolism and a diffuse cortical hypometabolism, even in the absence of findings in these tests. However, it is necessary to standardize the PET images analysis by means of visual and voxel-based methods compared to normal databases to define the areas of pathological metabolism that may be unnoticed when using visual analysis exclusively.

Keywords:
Limbic encephalitis
Autoimmune encephalitis
Caspr2
18F-FDG PET/CT
Resumen

Un inicio temprano de la inmunoterapia es fundamental para mejorar el pronóstico de los pacientes con encefalitis aguda de origen autoinmune (EAI). Se ha propuesto un nuevo abordaje clínico para el diagnóstico temprano basado en aspectos clínicos y pruebas complementarias pero éstas pueden tener una sensibilidad limitada principalmente en las primeras semanas. Mientras que las formas más comunes de EAI (anti-LGI-1 y anti-NMDAR), muestran frecuentemente patrones de PET con 18Flúor-Fluordeoxiglucosa (PET-FDG) consistentes, las anti-CASPR2 son menos frecuentes y los patrones de PET-FDG no están establecidos. En nuestra experiencia la PET-FDG en la EAI anti-CASPR2 presenta un hipermetabolismo temporal medial y un déficit difuso cortical, incluso con pruebas complementarias negativas. No obstante, es necesaria la estandarización del análisis de las imágenes PET mediante métodos basados en vóxeles con comparación con bases de datos de normalidad para definir con claridad las áreas de metabolismo alterado que pueden pasar desapercibidas al análisis visual.

Palabras clave:
Encefalitis límbica
Encefalitis autoinmune
Caspr2
18F-FDG PET/CT

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