自身免疫性脑炎的临床及多模态磁共振影像特征分析

Analysis of clinical and multimodal magnetic resonance imaging characteristics of autoimmune encephalitis

目的探讨不同种类自身免疫性脑炎(AE)的临床特点及多序列磁共振影像(MRI)特征。方法回顾性分析2014年1月至2019年6月我院住院脑脊液自身免疫抗体阳性患者49例的临床表现及影像学特点。结果AE中41例出现精神行为异常,31例出现癫痫发作,抗NMDA受体组以精神行为异常为主,而LE组及AE综合征组则以癫痫为常见表现。脑脊液检查显示抗NMDA受体组以白细胞特别是淋巴细胞增高常见,LE组以蛋白增高为主。49例患者脑脊液抗体均为阳性。MRI阳性患者23例,主要表现为单侧或双侧单个或多个脑区的T1WI低信号、T2WI及FLAIR高信号,FLAIR信号为敏感序列,部分病灶DWI呈高信号,增强扫描部分病灶强化。结论AE以精神行为异常、癫痫发作为主要特点,MRI对于AE有一定诊断价值,AE脑脊液抗体滴度检测为重要的确诊指标。只有对AE临床及影像特征有所了解,才能为临床选择下一步检查手段提供依据。

Objective To discuss the clinical and magnetic resonance imaging(MRI)features of different subtypes autoimmune encephalitis(AE).Methods From January 2014 to June 2019,the clinical manifestations and imaging features of 49 patients with positive cerebrospinal fluid antibody from our hospital were analyzed.Results In AE patients,41 cases suffered abnormal mental behavior,31 cases suffered epileptic seizure.The anti-NMDA receptor group mainly had mental abnormalities while the LE group and the AE syndrome group showed epilepsy as the common manifestation.Cerebrospinal fluid examination showed that white blood cell especially lymphocyte increased in the anti-NMDA antibody group,and protein increased in the LE group.All 49 patients had positive antibody in cerebrospinal fluid.A total of 23 patients had positive MRI finding,the main manifestations were low signal on T1WI,high signal on T2WI and FLAIR,and the FLAIR signal was a sensitive sequence.DWI of some lesions showed high signal and some lesions were enhanced by enhanced scanning.Conclusion AE is with the initial symptoms of psychiatric symptoms and epilepsy,MRI has certain diagnostic value for AE,and the cerebrospinal fluid antibody titer is an important index for AE diagnose.Only knowing the clinical and imaging features of AE can provide the basis for clinical selection of the next step examination.