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Case Reports
. 2022 Sep 14:29:100426.
doi: 10.1016/j.ensci.2022.100426. eCollection 2022 Dec.

Serial assessment of multimodality imaging in anti-leucine-rich glioma-inactivated 1 antibody encephalitis: A case report

Takafumi Wada  1 , Hitoshi Mori  1 , Katsuro Shindo  1
Affiliations
Case Reports

Serial assessment of multimodality imaging in anti-leucine-rich glioma-inactivated 1 antibody encephalitis: A case report

Takafumi Wada et al. eNeurologicalSci. .

Erratum in

Abstract

In autoimmune encephalitis, abnormalities of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), arterial spin labeling (ASL) in magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) and 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) have been reported. However, there are few studies of long-term follow-up of imaging. We report a case of anti-leucine-rich glioma-inactivated 1 antibody encephalitis whose MRI (DWI, FLAIR and ASL), 99mTcHM-PAO SPECT (PAO-SPECT) and 18F-FDG-PET were evaluated through the clinical course. ASL, PAO-SPECT and 18F-FDG-PET consistently showed abnormalities in almost the same area. Serial assessment of these imaging modalities is useful in evaluating disease activity and efficacy of treatment.

Keywords: 18F-FDG-PET; ASL; Anti-LGI1 encephalitis; SPECT.

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Conflict of interest statement

None.

Figures

Unlabelled Image
Graphical abstract
Fig. 1
Fig. 1
Images on admission. The MRI machine was PHLIPS Ingenia 3.0 T, using dS Head 32ch 3.0 T coil. A) DWI. There is slightly high intensity in the left mesial temporal lobe. B) FLAIR. The left mesial temporal lobe shows hyper intensity. C) ASL. There is increased cerebral blood flow in the left mesial temporal lobe. Post labeling delay was 2500 ms. D) PAO-SPECT. It shows increased cerebral blood flow in the left mesial temporal lobe. SPECT was performed using the following protocol: 1110 MBq of 99mTc-HMPAO was administered, and imaging was performed on a Dual-head SPECT scanner: Symbia T2 (Siemens Japan) starting about 5 min later. E) 18F-FDG-PET. There is hyper metabolism in the left mesial temporal lobe, which is coinciding with the region of increased cerebral blood flow in ASL. It was performed using the following protocol: 60 min after administration of 288.2 MBq 18F-FDG, CT was performed, followed by PET from the parietal to the thighs. Abbreviations; MRI, magnetic resonance imaging; DWI, diffusion-weighted imaging; FLAIR; fluid-attenuated inversion recovery; ASL, arterial spin labeling; PAO-SPECT, 99mTcHM-PAO single-photon emission computed tomography; 18F-FDG-PET, 18F-fluorodeoxyglucose-positron emission tomography; CT, computed tomography.
Fig. 2
Fig. 2
Images after the treatment of intravenous methylprednisolone, plasma exchange, and IVIg. All imaging protocols are the same as Fig. 1. A) DWI. High intensity in the left temporal lobe was reduced. High intensity in the right temporal lobe is not apparent. B) FLAIR. High intensity in the left temporal lobe is reduced, but faint high intensity in the right temporal lobe appeared. C) ASL. The hyper perfusion area in the left temporal lobe is reduced. On the other hand, increased cerebral blood flow is newly detected in the right mesial temporal lobe. D) PAO-SPECT. Similar to ASL, there is an area of increased blood flow in the right mesial temporal lobe. Abbreviations; IVIg, intravenous immunoglobulin; DWI, diffusion-weighted imaging; FLAIR; fluid-attenuated inversion recovery; ASL, arterial spin labeling; PAO-SPECT, 99mTcHM-PAO single-photon emission computed tomography.
Fig. 3
Fig. 3
Images after intravenous cyclophosphamide. All imaging protocols were same as Fig. 1 and Fig. 2. A) DWI. High intensity in the right mesial temporal lobe is apparent. B) FLAIR. High intensity in the right mesial temporal lobe is enhanced. On the other hand, there is a residual high signal in the left temporal lobe. C) ASL. Increased cerebral blood flow in the right mesial temporal lobe is evident. The hyper perfusion area in the left temporal lobe disappears. D) PAO-SPECT. There is increased cerebral blood flow in the right mesial temporal lobe. The hyper perfusion area in the left temporal lobe is reduced. E) 18F-FDG-PET. Hyper metabolism is observed in the right mesial temporal lobe, which is almost coincident with the hyper perfusion area of ASL. Hyper metabolism in the left temporal lobe disappears. Abbreviations; DWI, diffusion-weighted imaging; FLAIR; fluid-attenuated inversion recovery; ASL, arterial spin labeling; PAO-SPECT, 99mTcHM-PAO single-photon emission computed tomography; 18F-FDG-PET, 18F-fluorodeoxyglucose-positron emission tomography.
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