Use of single photon emission computed tomography and magnetic resonance to evaluate central nervous system involvement in patients with juvenile systemic lupus erythematosus

Abstract

The objective of the present study was to identify the single photon emission computed tomography (SPECT) and magnetic resonance (MR) findings in juvenile systemic lupus erythematosus (JSLE) patients with CNS involvement and to try to correlate them with neurological clinical history data and neurological clinical examination. Nineteen patients with JSLE (16 girls and 3 boys, mean age at onset 9.2 years) were submitted to neurological examination, electroencephalography, cerebrospinal fluid analysis, SPECT and MR. All the evaluations were made separately within a period of 15 days. SPECT and MR findings were analyzed independently by two radiologists. Electroencephalography and cerebrospinal fluid analysis revealed no relevant alterations. Ten of 19 patients (53%) presented neurological abnormalities including present or past neurological clinical history (8/19, 42%), abnormal neurological clinical examination (5/19, 26%), and abnormal SPECT or MR (8/19, 42% and 3/19, 16%, respectively). The most common changes in SPECT were cerebral hypoperfusion and heterogeneous distribution of blood flow. The most common abnormalities in MR were leukomalacia and diffuse alterations of white matter. There was a correlation between SPECT and MR (P<0.05). We conclude that SPECT and MR are complementary and useful exams in the evaluation of neurological involvement of lupus.

Cerebral and Cerebellar Volume Loss in Children and Adolescents with Systemic Lupus Erythematosus: A Review of Clinically Acquired Brain Magnetic Resonance Imaging

“…Small prospective studies and retrospective reviews of conventional structural brain imaging [computed tomography (CT) and MRI] describe prominent rates of cerebral atrophy and white matter lesions in pediatric lupus patients 13,14 . There have been no published pediatric lupus MRI studies utilizing quantitative volumetric analyses.…”

Brain Morphometric Changes Associated With Childhood‐Onset Systemic Lupus Erythematosus and Neurocognitive Deficit

“…Standard clinical magnetic resonance imaging (MRI) techniques using measures of ventricular size, the number of T2 hyperintense lesions, or global measures of tissue integrity () have shown a relationship to neurocognitive deficit in adults with SLE. Studies of childhood‐onset SLE suggest imaging abnormalities in 20–46% of patients, as determined using qualitative or subjective measures of lesion burden and measures of global atrophy (). However, such measures may lead to bias due to the subjective and operator‐dependent nature of the assessments, and are unable to localize specific regional involvement in childhood‐onset SLE–associated neurocognitive deficit.…”

Current International Guidelines for the Diagnosis and Treatment of Juvenile-Onset Systemic Lupus Erythematosus

“…Как и в случае развития неврологических или психических нарушений у взрослых, ни один клинический, лабораторный, нейропсихологический или визуальный тест не может использоваться у детей для дифференциации нейролюпуса от других причин нейропсихиатрической симптоматики. Были проведены небольшие когортные исследования, направленные на выявление специфических биомаркеров или на оценку данных нейровизуализирующих методов исследования для уточнения особенностей нейропсихиатрических проявлений в рамках СКВ у детей, но их сложно экстраполировать на всех пациентов, а большие контролируемые исследования в этой сфере, к сожалению, не проводились [108][109][110][111][112][113][114][115][116][117][118][119][120], в связи с чем в контексте предполагаемого диагноза нейролюпуса или ухудшения неврологической и психической симптоматики исходный дифференциально-диагностический поиск должен включать все другие потенциальные причины.…”