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

Yoshida, Atsuko; Shishido, Fumio; Kato, Kazuo; Watanabe, Hiroshi; Seino, Osamu

doi:10.1007/s12149-006-0006-7

Cited by 17 publications

(12 citation statements)

References 19 publications

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“…TCD allows portable, noninvasive measurement of blood velocity in the accessible cerebral vessels, in particular the middle cerebral arteries (MCA), and permits derivative calculations of standard RI and PI indices (10–16) which correlate linearly with cerebral hemispheric arteriolar tone, blood flow resistances, and impedances, all of which participate in the regulation of cerebral blood flow (17–19). Accordingly, based on reported changes in cerebral perfusion in SLE, we hypothesized that there would be significant differences in RI and PI between SLE patients and healthy, age and gender matched controls (6–8). …”

Section: Introductionmentioning

confidence: 99%

Middle cerebral artery resistivity and pulsatility indices in systemic lupus erythematosus: evidence for hyperperfusion

Greene

Yonan

Sharrar

et al. 2011

Lupus

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Background and purpose Systemic lupus erythematosus (SLE) is associated with significant cerebrovascular and neuropsychiatric disease for which multiple pathogeneses have been proposed. Although global cerebral hypoperfusion has been proposed, there are limited data about intracerebral arterial hemodynamics. Transcranial Doppler (TCD) allows portable, high temporal and spatial resolution, noninvasive blood velocity measurements in the middle cerebral arteries, and calculations of standard resistivity (RI) and pulsatility (PI) indices. RI and PI correlate with cerebral hemispheric arteriolar tone, blood flow resistances, and impedances. Accordingly, we hypothesized that there would be significant differences (p<0.05) in RI and PI between SLE patients and healthy, age and gender matched controls. Methods TCD was used to measure RI and PI bilaterally on 34 stable SLE patients (35±11 years) and 15 control subjects (34±10 years). Patients and controls had similar, normal blood pressures and were examined in the supine position during normal, resting respiration. RI and PI were determined by a blinded, experienced observer. Results There were no significant differences in RI and PI bilaterally within each cohort. However, SLE patients had significantly lower average RI and PI values compared with controls: 0.45±0.10 versus 0.52±0.05 (p<0.05); and 0.65±0.19 versus 0.77±0.12, (p<0.05); respectively. Conclusions These preliminary data suggest that RI and PI values in the human middle cerebral artery are significantly lower in SLE compared with controls. These indices indicate that middle cerebral arterial resistances and impedances are decreased in SLE. Under normotensive conditions, the results are consistent with hyperperfusion in SLE with increased arteriolar dilation and increased cerebral blood flow.

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Section: Introductionmentioning

confidence: 99%

Middle cerebral artery resistivity and pulsatility indices in systemic lupus erythematosus: evidence for hyperperfusion

Greene

Yonan

Sharrar

et al. 2011

Lupus

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“…Evidence of brain injury and altered brain physiology in SLE also comes from studies on neurometabolism measured by 18 F fluorodeoxyglucose ( 18 FDG) positron emission tomography (PET) or magnetic resonance spectroscopy (MRS) (3–8), and radionuclide cerebral blood flow (CBF) studies (3, 8–21), the overwhelming majority based on single photon emission computed tomography (SPECT). Diffuse patchy areas of regionally reduced perfusion have been reported in diffuse neuropsychiatric SLE (NPSLE) syndromes, while focal areas of regionally reduced perfusion may occur in focal NPSLE (13, 16–18). These abnormalities may be conspicuous in presumed areas of neurologic impairment and improve with corticosteroid therapy or clinical resolution (15, 19).…”

Section: Introductionmentioning

confidence: 99%

Elevated Cerebral Blood Flow and Volume in Systemic Lupus Measured by Dynamic Susceptibility Contrast Magnetic Resonance Imaging

Gasparovic¹,

Roldan²,

Sibbitt³

et al. 2010

J Rheumatol

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Objective Several studies have examined abnormalities in cerebral blood flow (CBF) in patients with systemic lupus erythematosus (SLE). However, the majority of these studies have reported CBF relative to a region assumed to be normal in the brain. The purpose of the present study was to examine absolute differences in both regional CBF and cerebral blood volume (CBV) between SLE patients and healthy control subjects. Methods CBF and CBV were measured with dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI), a technique that provides an alternative to radionuclide perfusion studies and permits quantitative anatomic, CBF, and CBV imaging in a single scanning session. CBF and CBV were measured in both lesions and normal appearing tissue in the major cerebral and subcortical brain regions. Unlike most past perfusion studies on SLE, CBF and CBV values were not normalized to a region of brain assumed to be healthy. Results As expected, CBF and CBV within MRI-visible lesions were markedly reduced relative to surrounding normal appearing white matter. However, both CBF and CBV in normal appearing tissue were higher in SLE patient groups, with or without lesions, relative to the control group. Conclusion DSC MRI, without normalization to a region presumed to be healthy, revealed that CBF and CBV in normal appearing tissue in SLE patients is higher than CBF and CBV in control subjects. Since this finding was made in subgroups of patients with and with out lesions, the higher CBF and CBV appears to precede lesion pathology.

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“…The accurate diagnosis of primary NPSLE and its differentiation from secondary central nervous system involvement are challenging (11). Thus, NPLSE is one of the most difficult manifestations of lupus to diagnose.…”

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confidence: 99%

Antineuronal antibodies and electroneurophysiological studies in pediatric patients with neuropsychiatric systemic lupus erythematosus

Mostafa¹,

Nazif²,

Elshahawi³

et al. 2009

Pediatric Allergy Immunology

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Neuropsychiatric systemic lupus erythematosus (NPSLE) is one of the most difficult manifestations of lupus to diagnose. Measurement of serum brain autoantibodies and assessment of cognitive function by electroneurophysiological studies (electroencephalogram (EEG) and P300) have contributed to an earlier and a more specific diagnosis of NPSLE. Thus, we were stimulated to assess the value of serum antineuronal antibodies and electroneurophysiological studies in diagnosis and early prediction of NPSLE. To investigate this, assessment of serum antineuronal antibodies and cognitive function (clinically and by electroneurophysiological studies) was done in 30 lupus patients [14 (46.7%) with and 16 (53.3%) without clinical evidence of NPSLE] in comparison with 30 healthy matched subjects. Patients without clinical evidence of NPSLE were followed-up clinically by monthly neuropsychiatric evaluation for 18 months. Seropositivity for antineuronal antibodies and abnormalities of EEG and P300 (prolonged latency and/or low amplitude) were found in 60%, 50% and 70%, respectively of lupus patients. During follow-up, 8 out of the 16 patients without clinical evidence of NPSLE developed such evidence [six (75%) had antineuronal seropositivity, five (62.5%) had abnormal EEG, six (75%) had P300 abnormalities and all had at least one abnormal result of these parameters at the time of initial evaluation before clinical presentation of NPSLE]. In conclusion, serum antineuronal antibodies and electroneurophysiological studies may be reliable parameters for diagnosis and early prediction of NPSLE, especially when combined together, before clinical manifestations ensue. Further studies on a large scale are warranted to evaluate the predictive value of these parameters in NPSLE.

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

Abstract: Quantitative CBF may provide a useful tool to distinguish CNS lupus from non-CNS lupus.

Cited by 17 publications

References 19 publications

Middle cerebral artery resistivity and pulsatility indices in systemic lupus erythematosus: evidence for hyperperfusion

Middle cerebral artery resistivity and pulsatility indices in systemic lupus erythematosus: evidence for hyperperfusion

Elevated Cerebral Blood Flow and Volume in Systemic Lupus Measured by Dynamic Susceptibility Contrast Magnetic Resonance Imaging

Antineuronal antibodies and electroneurophysiological studies in pediatric patients with neuropsychiatric systemic lupus erythematosus

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