European Journal of Nuclear Medicine

, Volume 22, Issue 9, pp 1073–1077 | Cite as

18FDG PET and acetazolamide-enhanced99mTc-HMPAO SPET in systemic lupus erythematosus

  • Frank Grünwald
  • Axel Schomburg
  • Achim Badali
  • Jürgen Ruhlmann
  • Laszlo Pavics
  • Hans-J. Biersack
Case report


In systemic lupus erythematosus (SLE), brain and kidney are the most frequently affected organs. Measurements of cerebral blood flow and metabolism by means of positron emission tomography (PET) and single-photon emission tomography (SPET) can contribute to the diagnostic assessment of the involvement of the central nervous system (CNS) in SLE. Functional imaging has been proven to be more sensitive than morphological imaging (magnetic resonance imaging and computed tomography). In this report, we present the case of a 70-year-old female patient, suffering from SLE without symptoms of CNS involvement. In addition to a SPET study using technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) and a PET scan with fluorine-18 deoxyglucose (18FDG), a SPET study after acetazolamide injection was performed in order to assess the cerebral perfusion reserve. While the PET scan showed no major abnormalities, and the baseline SPET study revealed only minor changes, the acetazolamide-enhanced SPET study revealed a marked reduction of the cortical perfusion reserve, particularly in both frontal lobes. It is concluded that “preclinical” CNS involvement, mainly caused by pathological mechanisms involving the cerebral blood vessels, can be considered to exist in this patient with SLE.

Key words

Fluorine-18 deoxyglucose Positron emission tomography Technetium-99m hexamethylpropylene amine oxime Single-photon emission tomography Acetazolamide 


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  1. 1.
    Hughes RAC. Cerebral lupus; pathogenesis of neurological involvement in SLE.Lancet 1994; 343: 580–581.Google Scholar
  2. 2.
    Van Dam AP. Diagnosis and pathogenesis of CNS lupus.Rheumatol Int 1991; 11: 1–11.Google Scholar
  3. 3.
    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.Google Scholar
  4. 4.
    Gaylis NB, Altmann 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.Google Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    Aisen AM, Gabrielsen TO, McCune WJ. MR imaging of systemic lupus erythematosus involving the brain.AJR 1985; 144:1027–1031.Google Scholar
  7. 7.
    Pinching AJ, Travers RL, Hughes GRV Oxygen-15 brain scanning for detection of cerebral involvement in systemic lupus erythematosus.Lancet 1978; I: 898–900.Google Scholar
  8. 8.
    Stoppe G, Wildhagen K, Seidel JW, Meyer GJ, Schober O, Heintz P, Kunkel H, Deicher H, Hundeshagen H. Positron emission tomography in neuropsychiatric lupus erythematosus.Neurology 1990; 40: 304–308.Google Scholar
  9. 9.
    Hiraiwa M, Nonaka C, Abe T, Lio M. Positron emission tomography in systemic lupus erythematosus: relation of cerebral vasculitis to PET findings.Am J Neuroradiol 1983; 4: 541–543.Google Scholar
  10. 10.
    Carbotte RM, Denburg SD, Denburg JA, Nahmias C, Garnett ES. Fluctuating cognitive abnormalities and cerebral glucose metabolism in neuropsychiatric systemic lupus erythematosus.J Neurol Neurosurg Psychiatry 1992; 55: 1054–1059.Google Scholar
  11. 11.
    Ehrenheim C, Burchert W, Sailer M, Wildhagen K, Deicher H, Hundeshagen H. Cerebral MRI and PET in patients with systemic lupus erythematosus (SLE).Eur J Nucl Med 1993; 20: 821.Google Scholar
  12. 12.
    Rubbert A, Marienhagen J, Pimer K, Manger B, Grebmeier J, Engelhardt A, Wolf F, Kalden JR. 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.Google Scholar
  13. 13.
    Kushner MJ, Tobin M, Fazekas F, Chawluk J, Jamieson D, Freundlich B, Grenell S, Freeman L, Reivich M. Cerebral blood flow variations in CNS lupus.Neurology 1990; 40: 99–102.Google Scholar
  14. 14.
    Emmi L, Bramati M, De-Christofaro MT, Mascalchi M, DalPozzo G, Marconi GP, Massai G, Passaleva A. MRI and SPECT investigations of the CNS in SLE patients.Clin Exp Rheumatol 1993; 11: 13–20.Google Scholar
  15. 15.
    Maeshima E, Maeshima S, Yamada Y, Yukawa S. Antiphospholipid antibodies and regional cerebral blood flow in systemic lupus erythematosus.Ryumachi 1993; 33: 125–130.Google Scholar
  16. 16.
    Nossent JC, Hovestadt A, Schonfeld DH, Swaak AJ. Single-photon emission computed tomography of the brain in the evaluation of cerebral lupus.Arthritis Rheum 1991; 34: 1397–1403.Google Scholar
  17. 17.
    Robers MP, Waterhouse E, Nagel JS, Roberts NW, Stern SH, Fraser P, Partridge R, Murawski B, Khoshbin S, Holman BL. 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.Google Scholar
  18. 18.
    Colamussi P, Giganti M, Cittanti C, Dovigo L, Uccelli L, Piffanelli A. Brain SPET evaluation of central nervous system (CNS) involvement in systemic lupus erythematosus (SLE).Eur J Nucl Med 1993; 20: 821.Google Scholar
  19. 19.
    Szer IS, Miller JH, Rawlings D, Shaham B, Bernstein B. Cerebral perfusion abnormalities in children with central nervous system manifestations of lupus detected by single photon emission computed tomography.J Rheumatol 1993; 20: 2143–2148.Google Scholar
  20. 20.
    Honer WG, Prohovnik I. Organic disorder and vascular dysregulation in systemic lupus erythematosus.Can J Psychiatry 1989;34:134–136.Google Scholar
  21. 21.
    Colamussi P, Giganti M, Cittanti C, et al. Brain single-photon emission tomography with99mTc-HMPAO in neuropsychiatric systemic lupus erythematosus: relations with EEG and MRI findings and clinical manifestations.Eur J Nucl Med 1995; 22:17–24.Google Scholar
  22. 22.
    Burt RW, Witt RM, Cikrit DF, Reddy RV. Carotid artery disease: evaluation with acetazolamide-enhanced Tc-99mHMPAO-SPECT.Radiology 1992; 182:461–466.Google Scholar
  23. 23.
    Holman BL, Carvalho PA, Zimmerman RE, Johnson KA, Tumeh SS, Smith AP, Genna S. Brain perfusion SPECT using an annular single crystal camera: initial clinical experience.J Nucl Med 1990; 31: 1456–1561.Google Scholar
  24. 24.
    Grünwald F, Menzel C, Pavics L, Bauer J, Hufnagel A, Reichmann K, Sakowski R, Elger E, Biersack H.J. Ictal and interictal brain SPECT imaging in epilepsy using technetium-99mECD.J Nucl Med 1994; 35: 1896–1901.Google Scholar
  25. 25.
    Grünwald F, Broich K, Hartmann A, Adam S, Erkwoh R, Bockisch A, Frede S, Hotze A, Reichmann K, Biersack H.J. Photon-emission computed tomograph in the diagnosis of Alzheimer type dementia.Dtsch Med Wochenschr 1988; 113: 208–212.Google Scholar
  26. 26.
    Perani D, DiPiero 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.Google Scholar
  27. 27.
    Johnson RT, Richardson EP. The neurological manifestations of systemic lupus erythematosus. A clinico-pathological study of 24 cases and review of the literature.Medicine 1968; 47: 337–369.Google Scholar
  28. 28.
    Hanson VG, Horowitz M, Rosenbluth D, Spiera H, Puszkin S. Systemic lupus erythematosus patients with central nervous system involvement show antibodies to a 50 kD neuronal membrane protein.J Exp Med 1992; 176: 565–573.Google Scholar
  29. 29.
    Cameron S. Cerebral lupus; management of cerebral lupus.Lancet 1994; 343: 581–582.Google Scholar
  30. 30.
    Csepany T. Cerebral systemic lupus erythematosus.Lancet 1994;343:1003.Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Frank Grünwald
    • 1
  • Axel Schomburg
    • 1
  • Achim Badali
    • 2
  • Jürgen Ruhlmann
    • 1
  • Laszlo Pavics
    • 1
  • Hans-J. Biersack
    • 1
  1. 1.Department of Nuclear MedicineUniversity of BonnBonnGermany
  2. 2.Department of DermatologyUniversity of BonnGermany

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