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Research ArticleAdult Brain
Open Access

Volumetry of Mesiotemporal Structures Reflects Serostatus in Patients with Limbic Encephalitis

L. Ernst, B. David, J. Gaubatz, I. Domínguez-Narciso, G. Lüchters, A.J. Becker, B. Weber, E. Hattingen, C.E. Elger and T. Rüber
American Journal of Neuroradiology December 2019, 40 (12) 2081-2089; DOI: https://doi.org/10.3174/ajnr.A6289
L. Ernst
aFrom the Department of Epileptology (L.E., B.D., J.G., I.D.-N., C.E.E., T.R.)
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B. David
aFrom the Department of Epileptology (L.E., B.D., J.G., I.D.-N., C.E.E., T.R.)
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J. Gaubatz
aFrom the Department of Epileptology (L.E., B.D., J.G., I.D.-N., C.E.E., T.R.)
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I. Domínguez-Narciso
aFrom the Department of Epileptology (L.E., B.D., J.G., I.D.-N., C.E.E., T.R.)
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G. Lüchters
eCenter for Development Research (G.L.), University of Bonn, Bonn, Germany
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A.J. Becker
bDepartment of Neuropathology (A.J.B.)
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B. Weber
cInstitute for Experimental Epileptology and Cognition Research (B.W.)
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E. Hattingen
dDepartment of Radiology (E.H.), University of Bonn Medical Center, Bonn, Germany
fDepartment of Neuroradiology (E.H.), Goethe University Frankfurt, Frankfurt, Germany
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C.E. Elger
aFrom the Department of Epileptology (L.E., B.D., J.G., I.D.-N., C.E.E., T.R.)
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T. Rüber
aFrom the Department of Epileptology (L.E., B.D., J.G., I.D.-N., C.E.E., T.R.)
gEpilepsy Center Frankfurt Rhine-Main (T.R.)
hDepartment of Neurology, and Center for Personalized Translational Epilepsy Research (T.R.), Goethe-University Frankfurt, Frankfurt am Main, Germany.
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    Fig 1.

    Volumetry of the amygdala and hippocampus. A, Volumetry in the early group. B, Volumetry in the late group. Asterisks represent levels of significance (single asterisk indicates .05; double asterisks, .01).

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    Fig 2.

    Starplots showing hippocampal subfield volume differences between patients in the early group and controls. Z values reflect the hippocampal subfield volume difference between patients in the early group and controls in the affected and the unaffected hemispheric sides. Underlined words indicate statistical significance of the respective hippocampal subfield (P < .05) in post hoc tests between patients and controls following a multivariate linear model (see MATERIALS AND METHODS and supporting information in On-line Tables 3–8). A, Relative hippocampal subfield volumes of the affected and unaffected sides of GAD-LE. B, Relative hippocampal subfield volumes of the affected and unaffected sides of VGKC-LE. GC-ML-DG indicates granule cell layer of the dentate gyrus; HATA, hippocampus-amygdala transition area.

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    Fig 3.

    Decision tree classification. Decision tree classification between LGI1 and GAD using hippocampal subfield volumes from the hemisphere affected in the EEG in early-stage LE. A, Decision tree with importance of features. B, Histogram showing the number of label-shift permutations for each accuracy bin. The solid red line displays a fitted Gaussian curve describing the underlying probability density function. The dashed purple line marks the classifier performance on the real data. C, Starplot showing Z values of the hippocampal subfield volume differences between LGI1-LE and GAD-LE in the affected hemispheric side (see supporting information in On-line Tables 3 and 5 for statistics). HATA indicates hippocampus-amygdala transition area; GC-ML-DG, granule cell layer of the dentate gyrus.

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    Fig 4.

    3D visualization showing hippocampal subfield volume differences between patients and controls. 3D visualization of group differences between all GAD–LE and controls (A) as well as between VGKC-LE and controls (B) using hippocampal subfield volumes from the affected hemisphere in early and late stages. Schematic scatterplots show Z values of volumes as a function of the approximate spatial distance from the amygdala. P indicates posterior; a, anterior; d, distance; V, volume. Please note the anterior-to-posterior gradient of subfield volume alterations in early GAD-LE and how the gradient tapers off in late GAD-LE.

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    Table 1:

    Demographic and clinical characteristics of subgroups of patients with limbic encephalitis and their corresponding control groups

    GAD-LEVGKC-LEGAD-CONVGKC-CON
    Early group
     No. (men)23 (7)25 (16)23 (7)25 (16)
     Age at MR imaging (mean) (yr)34.2 ± 11.259.5 ± 15.235.4 ± 10.657.2 ± 13.2
     Time between onseta and scan (mean) (mo)9.5 ± 7.47.6 ± 6.1NANA
     Interictal EEG lateralization5/12/1/57/8/2/8NANA
    (n = right/left/bilateral/unclear)
     No. of bilateral mesiotemporal FLAIR-T2-hyperintensities25NANA
     No. of first-line immunotherapies39NANA
     No. of second-line immunotherapies01NANA
    Late group
     No. (men)b33 (10)22 (10)33 (10)22 (10)
     Age at MR imaging (mean) (yr)33.9 ± 12.357.0 ± 16.834.4 ± 11.953.2 ± 13.2
     Time between onseta and scan (mean) (mo)62.5 ± 26.261.5 ± 23.6NANA
     Interictal EEG lateralization5/11/3/124/8/1/9NANA
    (n = right/left/bilateral/unclear)
     No. of bilateral mesiotemporal FLAIR-T2-hyperintensities43NANA
     No. of first-line immunotherapies1418NANA
     No. of second-line immunotherapies64NANA
    • Note:—NA indicates not applicable; CON, matched healthy control group.

    • ↵a Onset of the first limbic encephalitis–related symptom.

    • ↵b Patients scanned repeatedly were included in both (early and late) study groups (repeat scans GAD-LE: n = 10; repeat scans VGKC-LE, n = 13).

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American Journal of Neuroradiology: 40 (12)
American Journal of Neuroradiology
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L. Ernst, B. David, J. Gaubatz, I. Domínguez-Narciso, G. Lüchters, A.J. Becker, B. Weber, E. Hattingen, C.E. Elger, T. Rüber
Volumetry of Mesiotemporal Structures Reflects Serostatus in Patients with Limbic Encephalitis
American Journal of Neuroradiology Dec 2019, 40 (12) 2081-2089; DOI: 10.3174/ajnr.A6289

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Volumetry of Mesiotemporal Structures Reflects Serostatus in Patients with Limbic Encephalitis
L. Ernst, B. David, J. Gaubatz, I. Domínguez-Narciso, G. Lüchters, A.J. Becker, B. Weber, E. Hattingen, C.E. Elger, T. Rüber
American Journal of Neuroradiology Dec 2019, 40 (12) 2081-2089; DOI: 10.3174/ajnr.A6289
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