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Decrease in the cortex/striatum metabolic ratio on [18F]-FDG PET: a biomarker of autoimmune encephalitis

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Abstract

Purpose

The aim of this [18F]-FDG PET study was to determine the diagnostic value of the cortex/striatum metabolic ratio in a large cohort of patients suffering from autoimmune encephalitis (AE) and to search for correlations with the course of the disease.

Methods

We retrospectively collected clinical and paraclinical data of patients with AE, including brain 18F-FDG PET/CT. Whole-brain statistical analysis was performed using SPM8 software after activity parametrization to the striatum in comparison to healthy subjects. The discriminative performance of this metabolic ratio was evaluated in patients with AE using receiver operating characteristic curves against 44 healthy subjects and a control group of 688 patients with MCI. Relationship between cortex/striatum metabolic ratios and clinical/paraclinical data was assessed using univariate and multivariate analysis in patients with AE.

Results

Fifty-six patients with AE were included. In comparison to healthy subjects, voxel-based statistical analysis identified one large cluster (p-cluster < 0.05, FWE corrected) of widespread decreased cortex/striatum ratio in patients with AE. The mean metabolic ratio was significantly lower for AE patients (1.16 ± 0.13) than that for healthy subjects (1.39 ± 0.08; p < 0.001) and than that for MCI patients (1.32 ± 0.11; p < 0.001). A ratio threshold of 1.23 allowed to detect AE patients with a sensitivity of 71% and a specificity of 82% against MCI patients, and 98% against healthy subjects. A lower cortex/striatum metabolic ratio had a trend towards shorter delay before 18F-FDG PET/CT (p = 0.07) in multivariate analysis.

Conclusion

The decrease in the cortex/striatal metabolic ratio has a good early diagnostic performance for the differentiation of AE patients from controls.

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Data availability

The PET data that support the findings are available from the corresponding author upon reasonable request.

Code availability

Not applicable

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Funding

The local PET database of healthy controls was funded by APHM (regional PHRC; NCT00484523).

Author information

Authors and Affiliations

  1. Nuclear Medicine Department, Grenoble Alpes University Hospital, Grenoble, France

    Nicolas De Leiris & Jean Vervandier

  2. Laboratoire Radiopharmaceutiques Biocliniques, INSERM, Univ. Grenoble Alpes, 38000, Grenoble, France

    Nicolas De Leiris

  3. Service de Neurologie, Hôpital de La Timone, Pôle de Neurosciences Cliniques, Aix Marseille Univ, APHM, 13005, Marseille, France

    Berangère Ruel, Jean Pelletier & Elsa Kaphan

  4. Immunology Laboratory, INT, CNRS, AP-HM, Aix Marseille University, Marseille, France

    José Boucraut

  5. Department of Neurology and Movement Disorders, CHU Timone, APHM, Aix-Marseille Univ, 13385 Cedex 05, Marseille, France

    Stephan Grimaldi & Frederique Fluchere

  6. APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France

    Tatiana Horowitz, Jacques-Yves Campion & Eric Guedj

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Alzheimer’s Disease Neuroimaging Initiative

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Correspondence to Eric Guedj.

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Ethics approval

The retrospective observations required no ethical approval requirement other than informed consent and non-opposition (MR-004 French type). The local PET database of healthy controls was acquired in accordance with the Declaration of Helsinki, with informed written consent from the patients and approval from the “CPP Sud Méditerranée V” ethics committee.

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Informed written consent was obtained from all individual participants included in the study.

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Informed written consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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De Leiris, N., Ruel, B., Vervandier, J. et al. Decrease in the cortex/striatum metabolic ratio on [18F]-FDG PET: a biomarker of autoimmune encephalitis. Eur J Nucl Med Mol Imaging 49, 921–931 (2022). https://doi.org/10.1007/s00259-021-05507-9

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