Early and delayed Tc-99m ECD brain SPECT in SLE patients with CNS involvement

Abstract

We compared early and delayed Tc-99m ECD SPECT scans in 32 SLE patients (Group 1, definite neuropsychiatric disorders; Group 2, minor neurologic symptoms or normal) with those of normal controls by visual inspection and semi-quantitative evaluation. With visual interpretation, 13 out of 14 patients in Group 1 (93%) and 7 out of 18 patients in Group 2 (39%) had diffuse uneven decrease in early scans. Seven patients in Group 2 (39%) who had normal early scans demonstrated focal decrease in the medial frontal lobe in delayed scans. With cerebral region to cerebellar ratios, in early scans, the medial frontal lobe in Group 1 and Group 2 was significantly lower than in normal controls, and lateral frontal lobe and occipital lobes in Group 1 were significantly lower than in normal controls. Nevertheless, in delayed scans, every cortical region except for the parietal lobe in Groups 1 and 2 was significantly lower than in normal controls. The retention rates in all regions in SLE patients were significantly lower than in normal controls. No case showed SPECT improvement on follow-up studies in either group in spite of clinical improvement. Delayed Tc-99m ECD brain SPECT of high sensitivity might be useful in detecting CNS involvement. Although the SPECT findings did not correlate with the neuropsychiatric symptoms, early and delayed Tc-99m ECD SPECT seems to provide useful objective diagnostic information in SLE patients.

Cerebral Blood Flow in Depressed Patients with Systemic Lupus Erythematosus

“…In both cases, women are affected more often. Previous SPECT and PET studies on neuropsychiatric SLE did not distinguish depressed patients from patients with other psychiatric and neurological disorders, including schizophrenia, epilepsy, and stroke 6,8,11,12,13,31 . Suicide attempts are common to both disorders 2,3,17 .…”

“…Suicide attempts are common to both disorders 2,3,17 . CBF deficits were more frequent in patients with major neuropsychiatric symptoms than in patients with minor neuropsychiatric symptoms 5,6,14,31,32 , and in patients with abnormal MR compared to patients with normal MR results 11,12,13,14 . Independent of the nature of the association, it is of interest to assess whether MDD and SLE-related depression share a neural circuitry abnormality that could account for depressive symptoms.…”

Antibodies to microtubule‐associated protein 2 in patients with neuropsychiatric systemic lupus erythematosus

“…Neuropsychiatric SLE (NPSLE) affects a substantial proportion of SLE patients and may produce severe long-term functional consequences, including chronic central nervous system injury (1)(2)(3)(4). Various methods have been utilized to detect central nervous system lesions in patients with SLE, including lumbar puncture and cerebrospinal fluid examination, electroencephalography, cerebral angiography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography, brain imaging with 99m Tc-hexamethylpropylene amine oxime, and 99m Tc-ethyl cysteinate dimer brain single-photon-emission CT (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Immunologic tests which have been used to detect central nervous system involvement in SLE patients have included assays for serum and cerebrospinal fluid antineuronal antibodies (15), serum anti-ribosomal P antibodies (16,17), and serum antiphospholipid antibodies (aPL) (18,19).…”

Evaluation of cerebral perfusion in patients with neuropsychiatric systemic lupus erythematosus using 123I-IMP SPECT

“…It has been reported, however, that SLE patients showed hypoperfusion in the posterior cingulate gyrus and thalamus and this might be associated with the severity of psychiatric symptoms [23]. There are several other reports noting that delayed SPECT of high sensitivity might be useful in detecting CNS lupus [20] and that SPECT could be useful as a probe for biological markers of the presence of subclinical CNS involvement [6].…”

“…Cerebral perfusion SPECT, however, provides a sensitive tool for detecting CNS lupus. About 44%-93% of CNS lupus patients presented abnormal fi ndings, focal or multiple hypoperfusion area [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The commonly reported hypoperfusion areas include frontal lobe [6], frontal and parietal lobes [7], frontal, parietal and temporal lobes [8,9], parietal lobe [10,11], parietal and temporal lobes [12], and temporal lobe [13].…”