Diagnosis and monitoring of central nervous system involvement in systemic lupus erythematosus: value of F-18 fluorodeoxyglucose PET

Abstract

Objective-To investigate prospectively abnormalities of brain glucose utilisation in relation to major or minor neuropsychiatric symptoms in systemic lupus erythematosus (SLE). Methods-Positron emission tomography (PET) using F-18-labelled fluorodeoxyglucose was performed in 28 patients with SLE. Patients were classified as having severe neuropsychiatric manifestations (seizures, focal neurological deficits, acute confusional states, mood disorders) (n=12), or mild neuropsychiatric manifestations (headache, reactive depression, cognitive dysfunction, anxiety disorders) (n=11) and five patients without signs of central nervous system (CNS) involvement. Ten clinically and neurologically healthy volunteers served as controls. In 26 patients magnetic resonance imaging (MRI) was performed and autoantibodies against CNS tissue, ribosomal P protein and cardiolipin were measured. In 14 patients follow up PET scans were performed after a mean (SD) period of 11.6 (9.5) months. Results-PET scans showed hypometabolism in at least one brain region in all patients with severe or mild CNS symptoms (100%) as compared with patients without cerebral symptoms (40%) (p<0.0025). Parieto-occipital regions were most commonly aVected (96%), followed by parietal regions (32%). In contrast, MRI images were abnormal in only 11 of 22 patients (50%) with neuropsychiatric symptoms and in one of four patients (25%) without symptoms. In 12 of 14 patients examined in follow up PET scans persistence, improvement or worsening of cerebral symptoms were associated with unchanged, decreased or increased brain hypometabolism, respectively. No significant correlation was found between PET or MRI findings and autoantibody profiles. Conclusions-PET imaging represents a sensitive tool to detect manifest or subclinical CNS involvement in SLE and PET findings correlate well with the clinical course of disease.

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

“…For example, several studies reported either glucose hypometabolism or hypoperfusion in the temporal, parietal, and frontal lobes (Stoppe et al 1990;Lin et al 1997;Kao et al 1999). Weiner et al (2000) found hypometabolism in similar areas including the frontal lobes, but little involvement of temporal areas. Using high resolution instrumentation with SPECT, Kao et al (1999) detected deficits in deeper brain structures such as the basal ganglia.…”

Multimodal Electroneurophysiological Studies of Systemic Lupus erythematosus

“…Paiva et al [10] found that 10% of lupus patients without CNS symptoms had abnormal visual evoked potential (VEP), while 56% of those had CNS involvement. Waterloo et al [11] found abnormal EEG in 19% of patients with SLE, while magnetic resonance imaging was abnormal in 11 of 22 patients with neuropsychiatric symptoms and in 1 of 4 patients without symptoms [12].…”

Neuropsychiatrische Beteiligung des systemischen Lupus erythematodes

“…Im Gegensatz zur eingeschränkten Aussagekraft einer einzelnen MRT-Untersuchung zeigt sich, dass in MRT-Verlaufsuntersuchungen das Ansprechen auf eine Therapie dokumentiert werden kann [100]. [16], Kozora et al [56], Sabbadini et al [91], Sibbitt et al [95], Weiner et al [110]). …”

“…Bei Patienten mit APS finden sich MRT-Veränderungen in bis zu 75% der Fälle [45,79,92]. Wir fanden MRT-Auffälligkeiten bei 67% der Patienten mit schwerer neuropsychiatrischer Symptomatik und bei 30% der Patienten mit milden klinischen Symptomen [110]. Patienten zeigen sich in Abhängigkeit von der Erkrankungsdauer im MRT Auffälligkeiten in 16-52% vor allem in Form von kortikaler Atrophie und Marklagerläsionen [16,35,48,91,95,100].…”