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Clinical Neuroradiology

, Volume 29, Issue 4, pp 623–630 | Cite as

Limbic Encephalitis in Patients with Epilepsy—is Quantitative MRI Diagnostic?

  • Arndt-Hendrik Schievelkamp
  • Alina Jurcoane
  • Theodor Rüber
  • Leon Ernst
  • Andreas Müller
  • Burkhard Mädler
  • Hans Heinz Schild
  • Elke HattingenEmail author
Original Article
  • 150 Downloads

Abstract

Purpose

Limbic encephalitis (LE) is an immune-related disease with limbic symptoms, variable and asymmetric magnetic resonance imaging (MRI) aspects and antibody profiles. This study investigated the diagnostic value of quantitative relaxation times T2 (qT2) and MRI signal intensities (SI) in LE.

Methods

The prospective 3T-MRI study included 39 epilepsy patients with initially suspected LE and 20 healthy controls. Values and asymmetry indices of qT2, T2-weighted (T2-w) and proton density (PD)-w SI of manually delineated and automatically segmented amygdala and hippocampus were measured. Additionally, two raters made a blinded visual analysis on FLAIR (fluid attenuation inversion recovery) and T2-w images.

Results

According to diagnostic guidelines, 22 patients had probable LE and 17 patients had possible LE. The qT2 was higher (p < 0.01) in patients than in controls (mean ± SD, amygdala 98 ± 7 ms vs. 90 ± 5 ms, hippocampus 101 ± 7 ms vs. 92 ± 3 ms), but was not different between probable and possible LE or between sides (left and right). The PD-w SI and T2-w SI were lower in patients than in controls but were not different between patient subgroups or between sides. Diagnostic performance of visual analysis was relatively poor.

Conclusions

Epilepsy patients with suspected LE had elevated qT2 in amygdala and hippocampus, whereas the expected T2-w SI increase was not found; however, the diagnostic value of qT2 remains questionable since it did not discriminate probable from possible LE.

Keywords

Limbic encephalitis Amygdala Hippocampus T2-weighted MRI T2-relaxation time 

Abbreviations

FLAIR

Fluid attenuation inversion recovery

FOV

Field of view

LE

Limbic encephalitis

LI

Laterality index

NMDA

N-methyl-D-aspartate receptor

PD

Proton density

PD-w

Proton density weighted

qT2

Quantified T2-relaxation time

ROI

Region of interest

SI

Signal intensity

T2-w

T2-weighted

TE

Echo time

TR

Repetition time

VGKC

Voltage-gated potassium channel

Notes

Conflict of interest

A.-H. Schievelkamp, A. Jurcoane, T. Rüber, L. Ernst, A. Müller, B. Mädler, H.H. Schild, E. Hattingen and declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Arndt-Hendrik Schievelkamp
    • 1
  • Alina Jurcoane
    • 1
  • Theodor Rüber
    • 2
  • Leon Ernst
    • 2
  • Andreas Müller
    • 1
  • Burkhard Mädler
    • 3
  • Hans Heinz Schild
    • 4
  • Elke Hattingen
    • 1
    Email author
  1. 1.Neuroradiology, Department of RadiologyUniversity Hospital BonnBonnGermany
  2. 2.Department of EpileptologyUniversity Hospital BonnBonnGermany
  3. 3.Philips GmbHUB HealthcareHamburgGermany
  4. 4.Department of RadiologyUniversity Hospital BonnBonnGermany

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