Discrepancy between regional cerebral blood flow and glucose metabolism of the brain in systemic lupus erythematosus patients with normal brain magnetic resonance imaging findings

Abstract

Objective. In this study, 2 updated brain-imaging modalities, technetium-99m hexamethylpropylene amine oxime-single-photon-emission computed tomo-graphy (HMPAO-SPECT) and fluorine-18 2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET), were used to simultaneously detect regional cerebral blood flow (rCBF) and glucose metabolism of the brain in patients with systemic lupus erythematosus (SLE). Methods. Twenty-five female SLE patients, ages 25-40 years, were enrolled in this study and assigned to 1 of 2 groups. Group 1 consisted of 13 patients with neuropsychiatric manifestations (7 had major and 6 had minor manifestations). Group 2 consisted of 12 patients without neuropsychiatric manifestations. Serum levels of anticardiolipin antibodies (aCL) and anti-ribosomal P antibodies (anti-P) were measured. All patients had normal brain magnetic resonance imaging (MRI) findings. Ten healthy female volunteers also underwent brain MRI, HMPAO-SPECT, and FDG-PET for comparison. Results. 99m Tc-HMPAO-SPECT revealed hypo-perfusion lesions in 11 (44%) of 25 SLE patients, including 9 (69%) of the 13 patients in group 1, 7 (100%) of the 7 patients with major manifestations, 2 (33%) of the 6 patients with minor manifestations, and 2 (17%) of the 12 patients in group 2. Parietal lobes were the areas most commonly involved. FDG-PET revealed hypome-tabolism in 7 (54%) of the group 1 patients, 6 (86%) of the 7 patients with major manifestations, and 1 (17%) of the 6 patients with minor manifestations. Temporal lobes were the most commonly involved areas. However, no significant hypometabolism brain lesions were found in group 2 patients. All of the 4 patients with headaches and dizziness or headaches alone had normal findings on HMPAO-SPECT and FDG-PET. Nine (36%) of the 25 patients were positive for aCL. However, the presence of aCL was not related to neuropsychiatric manifestations or to HMPAO-SPECT or FDG-PET findings. Five (20%) of the 25 patients had anti-P antibodies and psychosis/depression. Conclusion. In patients with normal brain MRI findings, decreases in glucose metabolism coupled with decreases in rCBF are associated with serious neuro-psychiatric SLE (NPSLE) presentations, while normal glucose metabolism with decreases in rCBF may be found in SLE patients with or without NPSLE.

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.…”

“…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.…”

“…Nevertheless, none of these studies related functional or metabolic abnormalities to specific cognitive processes, only to general cognitive measures or neuropsychiatric problems such as major manifestations of confusion, seizures, psychosis, and depression (Kao et al 1999). These studies, however, do provide data to support CNS pathophysiology in SLE patients with overt NP disturbances.…”

Neuropsychiatrische Beteiligung des systemischen Lupus erythematodes

“…Die häufige Beteiligung der parietalen und temporalen Region wird mit dem höheren Risiko für Mangelperfusion im Grenzscheidengebiet zwischen A. cerebri media und A. cerebri posterior interpretiert [18]. Multifokale Areale gestörten zerebralen Blutflusses finden sich bei 77-100% der untersuchten Patienten mit schwerer zerebraler Symptomatik, bei 33-85% der Patienten mit milder Symptomatik, aber auch bei asymptomatischen Patienten in 10-29% [27,50,60,89,91]. Eine mögliche Erklärung für Perfusionsdefizite bei asymptomatischen Patienten ist, dass diese umschriebenen Foci nur funktionell stumme Hirnareale betreffen.…”

“…Kodama ÜBERSICHT 0-40% bei asymptomatischen Patienten [50,101,110]. Im Gegensatz dazu wurde in einer Studie ein erniedrigter Glucosemetabolismus nur bei Patienten mit zahlreichen Marklagerläsionen im MRT nachgewiesen [93].…”