Voxel-based morphometry of brain SPECT can detect the presence of active central nervous system involvement in systemic lupus erythematosus

Appenzeller, Simone; Amorim, Bárbara Juarez; Ramos, Celso Darío; Rio, Pablo Augusto; Etchebehere, E. C. S. de C.; Camargo, Edwaldo E.; Cendes, Fernando; Costallat, Lílian Tereza Lavras

doi:10.1093/rheumatology/kel255

Cited by 22 publications

(18 citation statements)

References 45 publications

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“…However, as a limitation of the present study, SPECT measurements were qualitatively made. Recently developed quantitative methods for the analysis of SPECT images could help to better understand the mechanisms of cognitive dysfunction in SLE [34, 35]. In addition, lupus anticoagulant, not measured in our study, has been linked to lower cognitive performance in nSLE more specifically than anticardiolipin antibodies [10, 36].…”

Section: Discussionmentioning

confidence: 88%

Cognitive Dysfunction in Systemic Lupus Erythematosus: Prevalence and Correlates

Olazarán

López-Longo²,

Cruz

et al. 2009

Eur Neurol

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Little is known about the mechanisms and relevance of cognitive dysfunction in systemic lupus erythematosus (SLE) patients who never displayed major neuropsychiatric manifestations (nSLE). Thirty-one nSLE female patients and 31 cognitively healthy control women were recruited. Sociodemographic, clinical, neuropsychological and SLE-related markers were collected including cerebral perfusion by single-photon emission computed tomography. Prevalences of cognitive complaints were 22.6% in nSLE versus 6.5% in the control group (p = 0.147); respective prevalences of cognitive dysfunction were 32.3 versus 6.5% (p = 0.01). Within the nSLE group, all cognitive domains appeared similarly affected, and correlations were found between cognitive dysfunction and less skilled occupation (r = –0.41, p = 0.02) and between cognitive complaints and depressive symptoms (r = 0.35, p = 0.05). Cognitive dysfunction is rather frequent in nSLE and seems to negatively impinge on social functioning.

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Section: Discussionmentioning

confidence: 88%

Cognitive Dysfunction in Systemic Lupus Erythematosus: Prevalence and Correlates

Olazarán

López-Longo²,

Cruz

et al. 2009

Eur Neurol

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“…For this analysis, we extracted ReHo values from ROIs selected either, because they presented significantly altered ReHo in this study and/or were previously reported to associate with SLE [Appenzeller et al, 2007a;Emmer et al, 2006]. These values were compared with SLEDAI score and daily GC dosage in individual non-NP-SLE patients; groupwise correlations were analyzed using the Spearman correlation test.…”

Section: Resultsmentioning

confidence: 99%

Localization of cerebral functional deficits in patients with non‐neuropsychiatric systemic lupus erythematosus

Lin¹,

Zhou²,

Wang³

et al. 2010

Human Brain Mapping

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Neuropsychiatric systemic lupus erythematosus (NP-SLE) is a common complication of systemic lupus erythematosus (SLE), and clinical interventions are of only limited efficacy despite relatively high prevalence. Such complications have been studied extensively, but the pathoetiology of NP-SLE has not yet been elucidated. Diagnosis of NP-SLE focuses primarily on psychological manifestations, and the underlying mechanisms leading to neuropsychiatric complications remain unknown. To address potential changes in brain function before NP-SLE development, we used resting-state functional magnetic resonance imaging (MRI) to compare regional brain activity in SLE patients versus matched controls. We report that regional activity in cerebellum and in areas of the default mode network are attenuated in patients with SLE, and moreover individual alterations in cerebellar activity correlated positively with the disease activity index. These findings provide direct evidence that significant alteration of brain function, resembling that observed in patients with NP-SLE, is already present in SLE patients without neuropsychiatric complications, highlighting the need for early evaluation and intervention in SLE patients. Furthermore, the disease activity rating correlated with regional functional alterations in the cerebellum, suggesting that the cerebellum could play a role in the pathogenesis of NP-SLE.

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“…However the authors found a global hypoperfusion in active NPSLE patients compared to healthy controls, which was mainly located in the cortical gray matter. Still, due to the relative nature of the underlying SPECT data, the interpretation of these analyses remains problematical (9). Furthermore, partial voluming effects, inherent to the relatively low spatial resolution of SPECT compared to perfusion weighted MR, cause incorrectly low perfusion values in atrophied areas, i.e., the gray matter.…”

Section: Discussionmentioning

confidence: 99%

“…On the one hand, previous investigators suggested patchy or random focal hypoperfusion, using single photon emission computed tomography (SPECT) in NPSLE patients (8). A recent study with SPECT suggested that the gray matter in SLE patients was relatively hypoperfused compared to healthy controls (9). On the other hand, Emmi et al (10) reported perfusion abnormalities in patients with severe, mild, and without NP symptoms and concluded that the role of cerebral blood flow (CBF) abnormalities remained unclear.…”

Section: Systemic Lupus Erythematosus (Sle)mentioning

confidence: 99%

Perfusion MRI in neuro‐psychiatric systemic lupus erthemathosus

Emmer

Osch

et al. 2010

Magnetic Resonance Imaging

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Purpose: To use perfusion weighted MR to quantify any perfusion abnormalities and to determine their contribution to neuropsychiatric (NP) involvement in systemic lupus erythematosus (SLE). Materials and methods:We applied dynamic susceptibility contrast (DSC) perfusion MRI in 15 active NPSLE, 26 inactive NPSLE patients, and 11 control subjects. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were reconstructed and regions of interest were compared between groups. In addition, the effect of SLE criteria, NPSLE syndromes, immunological coagulation disorder, and medication on CBF, CBV, and MTT was investigated.Results: No significant differences were found between the groups in CBF, CBV, and MTT. No significant influence of SLE criteria or NPSLE syndromes on CBF, CBV, or MTT was found. No significant influence of anti-cardiolipin antibodies, lupus anti-coagulant, the presence of anti-phospholipid syndrome (APS), or medication on CBF, CBV, or MTT was found. Conclusion:Our findings suggest CBF, CBV, and MTT in the white and the gray matter in SLE patients is not significantly different from healthy controls or between patients with and without specific symptoms or with and without immunological disorder involving coagulation.

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Voxel-based morphometry of brain SPECT can detect the presence of active central nervous system involvement in systemic lupus erythematosus

Abstract: VBM of BSI is a useful and objective method for detecting perfusion abnormalities in SLE patients, which is indicative of active CNS involvement. However, it is not helpful in differentiating the clinical sub-types of CNS involvement according to the ACR classification.

Cited by 22 publications

References 45 publications

Cognitive Dysfunction in Systemic Lupus Erythematosus: Prevalence and Correlates

Cognitive Dysfunction in Systemic Lupus Erythematosus: Prevalence and Correlates

Localization of cerebral functional deficits in patients with non‐neuropsychiatric systemic lupus erythematosus

Perfusion MRI in neuro‐psychiatric systemic lupus erthemathosus

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