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Contribution of diffusion-weighted imaging to distinguish herpetic encephalitis from auto-immune encephalitis at an early stage - 13/06/22

Doi : 10.1016/j.neurad.2022.05.003 
Alexandre Bani-Sadr a, b, 1, Marie-Camille Ruitton-Allinieu c, 1, Jean-Christophe Brisset d, François Ducray e, Bastien Joubert e, Géraldine Picard e, François Cotton b, c,
a Service de Radiologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France 
b Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Chemin du Grand-Revoyet, Pierre-Bénite 69495, France 
c INSA‐Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Université de Lyon, Pierre-Bénite F‐69495, France 
d Brisset-Li Consulting, Valbonne-Sophia-Antipolis, France 
e Centre National de Référence Pour les Syndromes Neurologiques Paranéoplasiques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France 

Corresponding author at: Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Chemin du Grand-Revoyet, Pierre-Bénite 69495, FranceService de RadiologieCentre Hospitalier Lyon-SudHospices Civils de LyonChemin du Grand-RevoyetPierre-Bénite69495France
En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Monday 13 June 2022

Abstract

Objectives

To determine whether diffusion-weighted imaging (DWI) can help to distinguish early stage autoimmune (AI) and herpes simplex virus (HSV) encephalitides.

Methods

This case-control study included patients from a multi-center cohort of AI encephalitides whose initial MRI including DWI was performed within ten days after symptoms onset. They were compared with patients with HSV encephalitis enrolled prospectively in a single-center from June, 2020 to December, 2020. The final diagnosis of AI encephalitis required a positive autoantibody assay, and that of HSV encephalitis required a positive HSV polymerase chain reaction based on cerebrospinal fluid. Brain MRI were evaluated for restricted diffusion, fluid-inversion recovery (FLAIR) abnormalities, lesion topography, hemorrhagic changes, and contrast enhancement.

Results

Forty-nine patients were included of which, 19 (38.8%) had AI encephalitis. Twenty-seven patients (55.1%) were males and the median age was 46.0 years (interquartile range (IQR):[22.0; 65.0]). Brain MRI were performed after a median of 4 days (IQR:[2.0; 7.0]) of symptom onset and time between symptom onset and MRI was not significantly different (p = 0.60). Twenty-six patients had restricted diffusion lesions in the medial temporal lobe, including 25/30 in the HSV encephalitis group (p < 0.001). FLAIR abnormalities were observed in 36 patients, including 29/30 in the HSV encephalitis group (p < 0.001). Lesion topography, hemorrhagic changes, and contrast enhancement did not differ significantly between the two groups.

Conclusion

Our results suggest that restricted diffusion lesions in the medial temporal lobe are a hallmark of HSV encephalitis and may help distinguish it from early-stage AI encephalitis.

El texto completo de este artículo está disponible en PDF.

Graphical abstract




Image, graphical abstract

El texto completo de este artículo está disponible en PDF.

Highlights

In this case-control study, the early brain MRIs of 49 patients with herpes encephalitis (n = 30) or autoimmune encephalitis (n = 19) were assessed retrospectively.
Twenty-six patients had restricted diffusion lesions in the medial temporal lobe, including 25/30 patients with herpetic encephalitis.
Restricted diffusion lesions in the medial temporal lobe are a hallmark of herpetic encephalitis and may help distinguish it from early-stage auto-immune encephalitis.

El texto completo de este artículo está disponible en PDF.

Keywords : Encephalitis, Herpes simplex, Limbis encephalitis, Anti-N-Methyl-D-aspartate receptor encephalitis, Diffusion magnetic resonance imaging

Abbreviations : DWI, AI, HSV, IQR, CSF, PCR, FLAIR, IQR, anti-NMDAr, anti-LGI1, anti-NDER, anti-YO, anti-VGCC


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© 2022  Elsevier Masson SAS. Reservados todos los derechos.
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