Brain volumetric changes in pediatric seronegative autoimmune encephalitis: A case-control study

Seronegative autoimmune encephalitis (SNAE) is an increasingly recognized entity in pediatric neurology, yet quantitative neuroimaging data remain scarce. This study aimed to evaluate regional brain volumetric differences between children diagnosed with SNAE and age- and sex-matched healthy controls using automated MRI volumetry. Fifteen children with SNAE (median age 12 years; 9 males, 6 females) and 45 age- and sex-matched healthy controls were enrolled. Three-dimensional T1-weighted MRI data were processed using the volBrain automated brain volumetry pipeline. Whole brain, grey matter, white matter, and subcortical structure volumes (thalamus, putamen, caudate, pallidum, hippocampus, amygdala, cerebellum, and brainstem) were compared between groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the discriminative value of significantly different volumetric parameters. Patients with SNAE demonstrated significantly lower absolute grey matter, thalamus, putamen, and pallidum volumes compared with healthy controls after Bonferroni correction. Following ICV-normalization, only putamen and pallidum volumes remained significantly reduced in the patient group. ROC analyses demonstrated significant discriminative performance for several volumetric parameters, with putamen showing the numerically highest AUROC among absolute volumetric measures (AUROC = 0.875) and pallidum showing the highest AUROC among ICV-normalized measures (AUROC = 0.769). Pairwise DeLong comparisons revealed that the ROC performances of these parameters were statistically indistinguishable within this sample. Automated brain volumetry may provide quantitative information complementary to conventional MRI evaluation in pediatric SNAE. Larger prospective studies are needed to validate the clinical significance of these findings.