The efficacy of brain F-fluorodeoxyglucose positron emission tomography in neuropsychiatric lupus patients with normal brain magnetic resonance imaging findings

Abstract

Brain involvement in systemic lupus erythematosus (SLE) is a significant source of morbidity and mortality. Therefore, the early detection and treatment of brain involvement in SLE is of utmost importance; however, a confirmative diagnostic tool for neuropsychiatric SLE is yet to be developed. In this study, we investigated the efficacy of (18)F-FDG-PET for detection of brain involvement in patients with SLE with normal magnetic resonance imaging (MRI) findings. Twenty patients with SLE, who presented with neuropsychiatric symptoms despite normal brain MRI findings and who underwent brain (18)F-FDG-PET, were enrolled. The most common neuropsychiatric manifestation was headache (45%), followed by seizure (20%) and mood disorder (20%). (18)F-FDG-PET revealed significant glucose metabolic abnormalities in 15 of 20 patients (75%). The temporal (55%) and the occipital (55%) lobes were the most susceptible brain regions, followed by the frontal lobe (50%). However, neuropsychiatric symptoms were not geographically correlated to (18)F-FDG-PET findings. Two patients with abnormal (18)F-FDG-PET findings underwent follow-up brain (18)F-FDG-PET after remission, which showed complete resolution of abnormal glucose metabolism. Our data suggest that (18)F-FDG-PET may be an additional diagnostic modality complementary to MRI, when MRI is unable to provide evidence of brain involvement in patients with SLE.

Metabolic and microstructural alterations in the SLE brain correlate with cognitive impairment

“…There have been many studies utilizing FDG-PET imaging in SLE and a variety of NPSLE syndromes that, in contrast to our results, have reported regional hypometabolism in the frontal, temporal, parietal, and parietal-occipital regions (21)(22)(23)(24)(25). Regional gray matter hypermetabolism has been reported rarely in the striatal nuclei and basal ganglia, typically in the clinical context of SLE patients with choreoathetoid movements (23,26,27). Several important differences in methodology may account for the dissimilarities with our results.…”

Reversible Amygdala and Parahippocampal Lesions of Brain 18Fluorodeoxy Glucose-Positron Emission Tomography in Neuropsychiatric Systemic Lupus Erythematosus

“…However, neuropsychiatric symptoms were not topographically correlated with the brain 18 FDG-PET findings. 4,19,20 In our reported case, the brain MRI also showed unremarkable findings, but a PET scan revealed exceptional hypermetabolism in both the amygdala and parahippocampal regions. We suggest that these findings reflect active inflammation by anti-NMDARs and are related to her neuropsychiatric manifestations.…”

Neuroimaging of translocator protein in patients with systemic lupus erythematosus: a pilot study using [11C]DPA-713 positron emission tomography

“…One may seek to explain the lower cerebellar TSPO binding in cognitively normal SLE subjects by degradation of tissue and apoptosis, which were thought to be responsible for regional brain hypometabolism (abnormally low glucose utilization) observed in both early-stage and late-stage SLE cohorts in previous studies 1, 32, 34 . However, hypometabolism was found only in the frontal and parietal cortices, but not in the cerebellum.…”