Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study
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In contrast to morphological imaging [such as magnetic resonance imaging (MRI) or computed tomography], functional imaging may be of advantage in the detection of brain abnormalities in cases of neuropsychiatric systemic lupus erythematosus (SLE). Therefore, we studied 13 patients (aged 40±14 years, 11 female, 2 male) with neuropsychiatric SLE who met four of the American Rheumatism Association criteria for the classification of SLE. Ten clinically and neurologically healthy volunteers served as controls (aged 40±12 years, 5 female, 5 male). Both groups were investigated using fluorine-18-labelled fluorodeoxyglucose brain positron emission tomography (PET) and cranial MRI. The normal controls and 11 of the 13 patients showed normal MRI scans. However, PET scan was abnormal in all 13 SLE patients. Significant group-to-group differences in the glucose metabolic index (GMI=region of interest uptake/global uptake at the level of the basal ganglia and thalamus) were found in the parieto-occipital region on both sides: the GMI of the parieto-occipital region on the right side was 0.922±0.045 in patients and 1.066±0.081 in controls (P<0.0001, Mann WhitneyU test), while on the left side it was 0.892±0.060 in patients and 1.034±0.051 in controls (P=0.0002). Parietooccipital hypometabolism is a conspicuous finding in mainly MRI-negative neuropsychiatric SLE. As the parieto-occipital region is located at the boundary of blood supply of all three major arteries, it could be the most vulnerable zone of the cerebrum and may be affected at an early stage of the cerebrovascular disease.
Key wordsNeuropsychiatrie systemic lupus erythematosus Positron emission tomography Fluorine-18 fluorodeoxyglucose Parieto-occipital brain hypometabolism
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- 2.Masdeu JC, VanHerretum RL, Kleiman A, Anselmi G, Kissane K, Horng J, Yudd A, Luck D, Grundman M. Early single photon emission computed tomography in mild head trauma, a controlled study.J Neuroimag 1994; 4: 177–181.Google Scholar
- 8.Yamakami I, Yamaura A, Isobe K. Types of traumatic brain injury and regional cerebral blood flow assessed by99mTc-HMPAO SPECT.Neurol Med Chir 1993; 33: 7–12.Google Scholar
- 9.Otte A, Mueller-Brand J, Fierz L. Brain SPECT findings in late whiplash syndrome.Lancet 1995; 345: 1513–1514.Google Scholar
- 13.Miller BL, Mena I, Daly J, Gombetti RJ, Goldberg MA, Lesser I, Garetti K, Villanueva-Meyer J, Liu CK. Temporo-parietal hypoperfusion with single photon emission computerized tomography in conditions other than Alzheimer's disease.Dementia 1990; 1: 41–45.Google Scholar
- 23.Huang SC, Carson R, Phelps M, Hoffman E, Schelbert H, Kuhl D. A boundary method for attenuation correction in positron emission tomography.IEEE Trans Nucl Sci 1981; 22: 627–637.Google Scholar
- 24.Graham DG, Brierly JB. Vascular disorders of the central nervous system. In: Adams J, ed.Neuropathology. London: Edward Arnold; 1984: 125–207.Google Scholar
- 25.Isshi K, Hirohata S, Hashimoto T, Miyashita H. Systemic lupus erythematosus presenting with diffuse low density lesions in the cerebral white matter on computed axial tomography scans: its implication in the pathogenesis of diffuse central nervous system lupus.J Rheumatol 1994; 21: 1758–1762.PubMedGoogle Scholar
- 28.Otte A, Ettlin TM, Fierz L, Kischka U, Muerner J, Mueller-Brand J. Brain perfusioin patterns in 136 patients with chronic symptoms after distorsion of the cervical spine using single photon emission computed tomography, technetium-99mHMPAO and technetium-99m-ECD: a controlled study.J Vasc Invest 1997; 3: 1–5.Google Scholar