Brain single-photon emission tomography with99mTc-HMPAO in neuropsychiatric systemic lupus erythematosus: relations with EEG and MRI findings and clinical manifestations
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Central nervous system (CNS) involvement in patients with systemic lupus erythematosus (SLE) is often difficult to evaluate because of protean neuropsychiatric (NP) manifestations and lack of reliable diagnostic markers. In the reported study the role of single-photon emission tomography (SPET) with technetium-99m hexamethylpropylene amine oxime (HMPAO) in the evaluation of CNS involvement in SLE was assessed and the relations between SPET perfusion defects, EEG examination, magnetic resonance imaging (MRI) findings and clinical presentation were examined. Twenty SLE patients with different NP manifestations were studied. Multiple areas of hypoperfusion, especially in the territory of the middle cerebral artery, were demonstrated by SPET analysis in all 20 patients. The number of hypoperfused areas and the degree of were more marked in patients with multiple NP manifestations. MRI and EEG evaluations were positive for 14 of 18 and for 12 of 20 patients, respectively. In the patients with positive SPET and MRI, 87 MRI focal lesions and 63 hypoperfused areas were found, and for 51 of these 63 at least one MRI lesion was found in the same anatomical region. SPET examination of patients with a normal EEG showed fewer hypoperfused areas and a lower degree of asymmetry compared to patients with an abnormal EEG. SPET of patients with focal EEG abnormalities showed more hypoperfused areas (difference not statistically significant) and a higher AI than did SPET of the patients with diffuse EEG abnormalities. Seven of 11 anatomical regions with focal EEG abnormalities. Seven of 11 anatomical regions with focal EEG abnormalities had co-localized hypoperfused areas and in two of these seven no detectable MRI lesions were found. The analysis of SPET and NP manifestations showed that 12 of 20 patients had at least one positive correlation, always involving the areas with the highest AI. In total, 51/88 (58%) hypoperfused areas correlated with the MRI findings and 31/88 (35%) with NP manifestations; for seven of the latter no concurrent MRI lesions were detected in the same anatomical region. It is concluded that SPET study of brain perfusion is a sensitive method for the evaluation of CNS involvement in SLE; furthermore, it is able to reveal disease progression and the lesions most relevant at the time of evaluation, and can objectify those NP manifestations without detectable MRI abnormalities. Nevertheless, because of the sensitivity of MRI in detecting morphological lesions, a complete evaluation of CNS involvement should be performed, combining SPET with MRI.
- O'Conner JF, Musher DM. Central nervous system involvement in systemic lupus erythematosus.Arch Neurol 1966; 14: 157–164.
- Estes D, Christian CL. The natural history of systemic lupus erythematosus by prospective analysis.Medicine 1971; 50: 85–93.
- Sergent JS, Lochshin MD, Klemperer MS, et al. Central nervous system disease in systemic lupus erythematosus: therapy and prognosis.Am J Med 1975; 58: 644–654.
- Feinglass EJ, Arnett FC, Dorsch CA, et al. Neuropsychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum and relationship to other features of the disease.Medicine 1976; 55: 323–339.
- McCune WJ, Golbus J. Neuropsychiatric lupus.Rheum Dis Clin North Am 1988; 14: 159–166.
- Johnson TR, Richardson EP. The neurological manifestations of systemic lupus erythematosus.Medicine 1968; 47: 337–369.
- Dubois EL, Tuffanelli DL. Clinical manifestations of SLE: computer analysis of 520 cases.JAMA 1964; 1: 104–111.
- Bluestein H. Neuropsychiatric manifestations of systemic lupus erythematosus.N Engl J Med 1987; 317: 309–311.
- Hanly JG, Walsh NMG, Sanalang V. Brain pathology in systemic lupus erythematosus.J Rheumatol 1992; 19: 732–741.
- Devinsky O, Petito CK, Alonso DR. Clinical and neuropathological findings in systemic lupus erythematosus: the role of vasculitis, heart emboli and thrombotic thrombocytopenia purpura.Ann Neurol 1988; 23: 380–384.
- Zvaifler NJ, Bluestein HG. The pathogenesis of central nervous system manifestations of systemic lupus erythematosus.Arthritis Rheum 1982; 25: 862–866.
- Wilson HA, Winfield JB, Lahita RG, et al. Association of IgG-anti brain antibodies with central nervous system dysfunction in systemic lupus erythematosus.Arthritis Rheum 1979; 22: 458–462.
- Howe A, Dent PB, Liao S-K, et al. Antineuronal antibodies in neuropsychiatric systemic lupus erythematosus.Arthritis Rheum 1985; 28: 789–795.
- Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoaugulant in systemic lupus erythematosus (SLE) and in non-SLE disorders.Ann Intern Med 1990; 112: 682–698.
- O'Connor P. Diagnosis of central nervous system lupus.Le Journal Canadien des Sciences Neurologiques 1988; 15: 257–260.
- Gaylis NB, Altman RD, Ostrov S, et al. The selective value of computed tomography of the brain in the cerebritis due to SLE.J Rheumatol 1982; 9: 850–854.
- Aisen AM, Gabrielsen TO, McCune WJ. MR imaging of systemic lupus erythematosus involving the brain.AJR 1985; 144: 1027–1031.
- McCune JW, MacGuire A, Aisen AM, et al. Identification of brain lesions in neuropsychiatric systemic lupus erythematosus by magnetic resonance scanning.Arthritis Rheum 1988; 31: 159–166.
- Stimmler MM, Coletti PM, Quisimorio FP Jr. Magnetic resonance imaging of the brain in neuropsychiatric systemic lupus erythematosus.Semin Arthritis Rheum 1993; 22: 335–349.
- Pinching AJ, Travers RL, Hughes GR, et al. Oxygen-15 brain scanning for detection of cerebral involvement in systemic lupus erythematosus.Lancet 1978; I: 898–900.
- Nossent JC, Hovestadt DH, Schonfeld DHW, et al. Single-photon emission computed tomography of the brain in the evaluation of cerebral lupus.Arthritis Rheum 1991; 34: 1397–1403.
- Emmi L, Bramati M, De Cristofaro MT, et al. MRI and SPECT investigations of the CNS in SLE patients.Clin Exp Rheumatol 1993; 11: 13–20.
- Awada HH, Mamo HL, Luft AG, et al. Cerebral blood flow in SLE with and without central nervous system involvement.J Neurol Neurosurg Psychiatry 1987; 50: 1597–1601.
- Volkow ND, Warner N, McIntyre R, et al. Cerebral involvement in systemic lupus erythematosus.Am J Physiol Imaging 1988; 3: 91–98.
- Kushner MJ, Tobin M, Fazekas F, et al. Cerebral blood flow variations in CNS lupus.Neurology 1990; 40: 99–102.
- Rogers MP, Waterhouse E, Nagel JS, et al. I-123 iofetamine SPECT scan in systemic lupus erythematosus patients with cognitive and other minor neuropsychiatric symptoms: a pilot study.Lupus 1992; 1: 215–219.
- Rubbert A, Marienhagen J, Pirner K, et al. Single photon emission computed tomography analysis of cerebral blood flow in the evaluation of central nervous system involvement in patients with systemic lupus erythematosus.Arthritis Rheum 1993; 36: 1253–1262.
- Carbotte RM, Denburg SD, Denburg JA, et al. Fluctuating cognitive abnormalities and cerebral glucose matabolism in neuropsychiatric systemic lupus erythematosus.J Neurol Neurosurg Psychiatry 1992; 55: 1054–1059.
- Stoppe G, Wildhagen K, Seidel JW, et al. Positron emission tomography in neuropsychiatric lupus erythematosus.Neurology 1990; 40: 304–308.
- Szer IS, Miller JI, Rawlings D, et al. Cerebral perfusion abnormalities in children with central nervous system manifestations of lupus detected by single photon emission computed tomography.J Rheum 1993; 20: 2142–2147.
- Perani D, Di Piero V, Vallar G, et al. Technetium-99m HMPAO-SPECT study of regional cerebral perfusion in early Alzheimer's disease.J Nucl Med 1988; 29: 1507–1514.
- Stefan H, Kulmen C, Biersack HJ, et al. Initial experience with 99mTc hexamethylpropylene amine oxime (HM-PAO) single photon emission computed tomography (SPECT) in patients with focal epilepsy.Epilepsy Res 1987; 1: 134–138.
- Lewis SW, Ford RA, Syed GM, et al. A controlled study of Tc-99m-HMPAO single photon emission imaging in chronic schizophrenia.Psychol Med 1992; 22: 27–32.
- Ell PJ, Hocknell JML, Jarrit PH, et al. A 99mTC labelled radiotracer for the investigation of cerebral vascular disease.Nucl Med Commun 1985; 6: 437–441.
- Pozzilli C, Passafiume D, Bernardi S. SPECT, MRI and cognitive functions in multiple sclerosis.J Neurol Neurosurg Psychiatry 1991; 54: 110–115.
- Broich K, Horwich D, Alavi A. HM-PAO SPECT and MRI in acute disseminated encephalomyelitis.J Nucl Med 1991; 32: 1897–1900.
- Meyer MA. Focal high uptake of HM-PAO in brain perfusion studies: a clue in the diagnosis of encephalitis.J Nucl Med 1990; 31: 1094–1098.
- Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus.Arthritis Rheum 1982; 25: 1271–1277.
- Diagnostic and statistical manual of mental disorders, 3rd edn, revised. Washington: American Psychiatric Association, 1987.
- Brain single-photon emission tomography with99mTc-HMPAO in neuropsychiatric systemic lupus erythematosus: relations with EEG and MRI findings and clinical manifestations
European Journal of Nuclear Medicine
Volume 22, Issue 1 , pp 17-24
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Regional cerebral blood flow
- Neuropsychiatric systemic lupus erythematosus
- Technetium 99m hexamethylpropylene amine oxime
- Single-photon emission tomography
- Industry Sectors
- Author Affiliations
- 1. Department of Nuclear Medicine, S. Anna Hospital and University of Ferrara, Cso Giovecca 203, I-44100, Ferrara, Italy
- 2. Institute of Neurology, University of Ferrara, Ferrara, Italy
- 3. Division of Rheumatology, S. Anna Hospital, Ferrara, Italy
- 4. Radiology Department, S. Anna Hospital, Ferrara, Italy
- 5. INB-CNR Department of Nuclear Medicine, H.S. Raffaele, Milan, Italy