Brain positron emission tomography imaging with 18Fluorine-fluorodeoxyglucose
(FDG-PET) has demonstrated utility in suspected autoimmune encephalitis. Visual and/or
assisted image reading is not well established to evaluate hypometabolism/hypermetabolism.
We retrospectively evaluated patients with autoimmune encephalitis between 2003 and 2018.
Patients underwent EEG, brain magnetic resonance imaging (MRI), cerebrospinal fluid (CSF)
sampling and autoantibodies testing. Individual FDG-PET images were evaluated by standard
visual reading and assisted by voxel-based analyses, compared to a normal database. For the
latter, three different methods were performed: two based on statistical surface projections (Siemens
syngo.via Database Comparison, and 3D-SSP Neurostat) and one based on statistical parametric
mapping (SPM12). Hypometabolic and hypermetabolic findings were grouped to identify specific
patterns. We found six cases with definite diagnosis of autoimmune encephalitis. Two cases had
anti-LGI1, one had anti-NMDA-R and two anti-CASPR2 antibodies, and one was seronegative.
18F-FDG-PET metabolic abnormalities were present in all cases, regardless of the method of analysis.
Medial–temporal and extra-limbic hypermetabolism were more clearly depicted by voxel-based
analyses. We found autoantibody-specific patterns in line with the literature. Statistical surface
projection (SSP) methods (Neurostat and syngo.via Database Comparison) were more sensitive
and localized larger hypermetabolic areas. As it may lead to comparable and accurate results,
visual analysis of FDG-PET studies for the diagnosis of autoimmune encephalitis benefits from
voxel-based analysis, beyond the approach based on MRI, CSF sample and EEG