Cerebral glucose hypometabolism and hypoperfusion of cingulate gyrus: an imaging biomarker of autoimmune encephalitis with psychiatric symptoms

• Published in: Journal of neurology Vol. 271; no. 3; pp. 1247 - 1255
• Main Authors: Sun, Yueqian, Li, Gongfei, Liu, Xiao, Zhao, Xiaobin, Ren, Jiechuan, Ren, Guoping, Liu, Yaou, Ai, Lin, Wang, Qun
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2024; Springer Nature B.V
• Subjects: Autoimmune diseases; Autoimmune Diseases of the Nervous System; Biomarkers - metabolism; Blood flow; Catatonia; Cerebral blood flow; Cerebrovascular Circulation - physiology; Computed tomography; Cortex (cingulate); Encephalitis; Encephalitis - diagnostic imaging; Encephalitis - metabolism; Glucose - metabolism; Glutamate decarboxylase; Glutamic acid; Gyrus Cinguli - diagnostic imaging; Humans; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Neuroimaging; Neurology; Neuroradiology; Neurosciences; Original Communication; Phenotypes; Positron emission tomography; Positron Emission Tomography Computed Tomography; Prognosis; Risk factors; Spin labeling; Tomography; Cingulate; Psychiatric symptoms; Positron emission tomography; Arterial spin labeling; Autoimmune encephalitis
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-023-12051-z

Background
About 60% of autoimmune encephalitis (AE) patients present psychiatric symptoms, but the underlying mechanism remains unknown. This study examined the role of the cingulate cortex in such patients to identify predictive poor psychiatric factors.
Methods
In this study, 49 AE patients and 39 healthy controls were enrolled. AE patients were further divided into two groups based on the presence/absence of psychiatric symptoms. The ratio of the standardized uptake value (SUVR) and relative cerebral blood flow (rCBF) in different regions of the cingulate cortex were calculated through positron emission tomography–computed tomography (PET/CT) and arterial spin labeling (ASL) MRI, and the results were compared among the three groups. In addition, we followed-up on the psychiatric outcomes and identified the risk factors for poor psychiatric prognosis, focusing on the cingulate cortex.
Results
More than half of the AE patients (27/49) exhibited psychiatric symptoms. Agitation and thought blocking were typical psychiatric phenotypes, except for anti-glutamic acid decarboxylase 65 (GAD65) encephalitis, which mainly presented with catatonia and a depressed mood. AE patients with psychiatric symptoms experienced reduced metabolism and perfusion of the anterior cingulate cortex (ACC), midcingulate cortex (MCC), and posterior cingulate cortex (PCC). The SUVR of ACC can be used as an independent risk factor of poor psychiatric outcomes, which had an area under the ROC curve (AUC) of 0.865.
Conclusion
Impaired cingulate cortex function in AE may be the potential mechanism of psychiatric symptoms. Hypometabolism of ACC is an independent prognostic factor predicting an unfavorable psychiatric prognosis in AE.