1. Conventional brain MRI features distinguishing limbic encephalitis from mesial temporal glioma
- Author
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Mario Ermani, Sergio Ferrari, Piera De Gaspari, Silvia Valeggia, Sara Mariotto, Renzo Manara, Matteo Gastaldi, Anna Pichiecchio, Giuseppe Lombardi, Vittorina Zagonel, Marco Zoccarato, Alessio Signori, Luigi Zuliani, Diego Franciotta, Bruno Giometto, Zoccarato, M., Valeggia, S., Zuliani, L., Gastaldi, M., Mariotto, S., Franciotta, D., Ferrari, S., Lombardi, G., Zagonel, V., De Gaspari, P., Ermani, M., Signori, A., Pichiecchio, A., Giometto, B., and Manara, R.
- Subjects
Male ,Pathology ,Fluid-attenuated inversion recovery ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Neuronal antibodie ,Retrospective Studie ,Diagnosis ,80 and over ,Neuroradiology ,Neuronal antibodies ,Aged, 80 and over ,medicine.diagnostic_test ,Brain Neoplasms ,Limbic encephalitis ,AK5 antibodies ,Brain MRI ,Glioma ,Adult ,Aged ,Autoimmune Diseases ,Diagnosis, Differential ,Female ,Humans ,Limbic Encephalitis ,Middle Aged ,Retrospective Studies ,Young Adult ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Cardiology and Cardiovascular Medicine ,Parahippocampal gyrus ,Human ,medicine.medical_specialty ,Autoimmune Disease ,White matter ,Brain Neoplasm ,03 medical and health sciences ,medicine ,Radiology, Nuclear Medicine and imaging ,business.industry ,Limbic Encephaliti ,Magnetic resonance imaging ,medicine.disease ,Hyperintensity ,AK5 antibodie ,Differential ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Purpose: Radiological hallmark of autoimmune limbic encephalitis (LE) is a hyperintense signal in MRI T2-weighted images of mesial temporal structures. We aimed to identify conventional magnetic resonance imaging (MRI) features that can help distinguish LE from temporal glioma. Methods: Brain MRIs of 25 patients affected by antibody-positive autoimmune LE, 24 patients affected by temporal glioma (tumor group), and 5 negative controls were retrospectively blindly evaluated in random order. Results: Ten brain MRIs from the LE group were correctly recognized; one additional patient with mesial temporal hyperintensity with anti-AK5 abs LE was wrongly diagnosed as having a tumor. The brain MRIs of the remaining 14 of the 25 patients with LE were judged negative or, in three cases, showed features not typical for LE. In the tumor group, all MRIs showed pathological alterations diagnosed as tumors in 22/24 cases and as LE in two (2/22, 9%). Unilateral lesions were more common in tumors than in neuroradiologically abnormal LE (96% vs. 18%, p < 0.001). T2/FLAIR hyperintensity of the parahippocampal gyrus was associated more with tumor than with LE (71% vs. 18%) (p = 0,009), as T2/FLAIR hyperintensity of extralimbic structures (p = 0.015), edema (p = 0.041), and mass effect (p = 0.015). Maintenance of gray/white matter distinction was strongly associated with LE (91% vs. 17%, p < 0.001). Conclusion: Conventional brain MRI is a fundamental tool in the differential diagnosis between LE and glioma. Bilateral involvement and maintenance of gray/white matter distinction at the cortical/subcortical interface are highly suggestive of LE.
- Published
- 2019