{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:11:07Z","timestamp":1777637467480,"version":"3.51.4"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016834","name":"Chongqing Municipal Health Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016834","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012669","name":"Natural Science Foundation Project of Chongqing, Chongqing Science and Technology Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012669","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis often causes cognitive impairment, yet conventional MRI lacks sensitivity to detect related microstructural changes. This study aimed to investigate T1-weighted\/T2-weighted (T1w\/T2w) ratios alterations in normal-appearing white matter (NAWM) and their relationship with cognitive function in patients with anti-NMDAR encephalitis, including a 12-month longitudinal follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifty-nine patients with anti-NMDAR encephalitis (31 with mild cognitive impairment (MCI), 28 with no cognitive impairment (NCI)) and 34 healthy controls (HCs) underwent 3.0T whole-brain MRI and comprehensive neuropsychological assessments, including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and domain-specific tests for attention-executive function, memory, and visuospatial reasoning. T1w\/T2w ratios were calculated for globel NAWM and multiple major white matter (WM) tracts. Eighteen MCI patients were followed longitudinally for 12 months to evaluate changes in T1w\/T2w ratios and cognitive performance over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with NCI patients and HCs, MCI patients exhibited significantly reduced T1w\/T2w ratios in global NAWM (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001) and multiple WM tracts, including the corpus callosum, fornix, left hippocampal cingulum, and right hippocampal cingulum (all\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.05). Lower ratios were significantly associated with worse global cognition (r = 0.364,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.023), memory (r = 0.336,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.023), and visuospatial reasoning performance (r = 0.397,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.005). In the 18 MCI patients with 12-month follow-up, increased T1w\/T2w ratios in the fornix and hippocampal cingulum (both\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.009) were accompanied by significant improvements in visuospatial reasoning and memory functions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>T1w\/T2w ratios derived from routine MRI provide a sensitive, clinically feasible biomarker for detecting NAWM microstructural damage in anti-NMDAR encephalitis. Longitudinal changes in these ratios may parallel cognitive improvement, and these preliminary findings support further investigation of this metric as an imaging biomarker, independent cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1796544","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:08:11Z","timestamp":1777442891000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Microstructural white matter alterations and cognitive impairment in anti-NMDAR encephalitis: evidence from T1w\/T2w ratio analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Jinyu","family":"Tao","sequence":"first","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, 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