Skip to main content
SpringerLink
Log in

Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study

  • Short Communication
  • Published:
European Journal of Nuclear Medicine Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Bavetta S, Nimmon CC, White J, McCabe J, Huneidi AH, Bomanji J, Birkenfeld B, Charlesworth M, Britton KE, Greenwood RJ. A prospective study comparing SPET with MRI and CT as prognostic indicators following severe closed head injury.Nucl Med Commun 1994; 15: 961–968.

    PubMed  Google Scholar 

  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 

  3. Prayer L, Wimberger D, Oder W, Kramer J, Schindler E, Podreka I, Imhof H. Cranial MR imaging and cerebral99mTc-HMPAO SPECT in patients with subacute or chronic severe closed head injury and normal CT examinations.Acta Radiol 1993; 34: 593–599.

    PubMed  Google Scholar 

  4. Newton MR, Greenwood RJ, Britton KE. A study comparing SPECT with CT and MRI after closed head injury.J Neurol Neurosurg Psychiatry 1992; 55: 92–94.

    PubMed  Google Scholar 

  5. Roper SN, Mena I, King WA, Schweitzer J, Garrett K, Mehninger CM, McBride D. An analysis of cerebral blood flow in acute closed head injury using technetium-99m-HMPAO SPECT and computed tomography.J Nucl Med 1991; 32: 1684–1687 (erratum 2070).

    PubMed  Google Scholar 

  6. Nedd K, Sfakianakis G, Ganz W, Uricchio B, Vernberg D, Villanueva P, Jabir AM, Bartlett J, Keena J.99mTc-HMPAO SPECT of the brain in mild to moderate traumatic brain injury patients compared with CT - a prospective study.Brain Inj 1993; 7: 469–479.

    PubMed  Google Scholar 

  7. Gray BG, Ichise M, Chung DG, Kirsh JC, Franks W. Technetium-99m-HMPAO SPECT in the evaluation of patients with a remote history of traumatic brain injury: a comparison with xray computed tomography.J Nucl Med 1992; 33: 52–58.

    PubMed  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 

  10. Otte A, Ettlin TM, Fierz L, Mueller-Brand J. Parieto-occipital hypoperfusion in late whiplash syndrome: first quantitative SPECT study using Tc-99m-bicisate (ECD).Eur J Nucl Med 1996;23:72–74.

    PubMed  Google Scholar 

  11. Friberg L. Cerebral blood flow changes in migraine: methods, observations and hypotheses.J Neurol 1991; 238 Suppl 1: S12-S17.

    PubMed  Google Scholar 

  12. Waldemar G, Bruhn P, Kristensen M, Johnsen A, Paulson O, Lassen NA. Heterogeneity of neocortical cerebral blood flow deficits in dementia of the Alzheimer type: a99mTc-HMPAO-SPECT studyJ Neurol Neurosurg Psychiatry 1994; 57: 285–295.

    PubMed  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 

  14. Grünwald F, Schomburg A, Badali A, Ruhlmann J, Pavics L, Biersack HJ.18FDG PET and azetaolamide-enhanced99mTc-HMPAO SPET in systemic lupus erythematosus.Eur J Nucl Med 1995; 22: 1073–1077.

    PubMed  Google Scholar 

  15. Sibbitt WL, Sibbitt RR. Magnetic resonance spectroscopy and positron emission tomography scanning in neuropsychiatric systemic lupus erythematosus.Rheum Dis Clin North Am 1993; 19: 851–868.

    PubMed  Google Scholar 

  16. Stoppe G, Wildhagen K, Meyer GJ, Schober O. Use of fluorodeoxyglucose PET in the diagnosis of central nervous system lupus erythematosus and a comparison with CT and MRI.Nuklearmedizin 1989; 28: 187–192.

    PubMed  Google Scholar 

  17. Kovacs JA, Urowitz MB, Gladman DD, Zeman R. The use of single photon emission computerized tomography in neuropsychiatric SLE: a pilot study.J Rheumatol 1995; 22: 1247–1253.

    PubMed  Google Scholar 

  18. Szer IS, Miller JH, Rawlings D, Shaham B, Bernstein B. Cerebral perfusion abnormalities in children with central nervous system manifestations of lupus by single photon emission computed tomography.J Rheumatol 1993; 20: 2143–2148.

    PubMed  Google Scholar 

  19. Tan EM, Cohen AS, Fried JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus (SLE).Arthritis Rheum 1982; 25: 1271–1277.

    PubMed  Google Scholar 

  20. Ettlin T, Kischka U, Reichmann S, Radü EW, Heim S, a Wengen D, Benson FD. Cerebral symptoms after whiplash injury of the neck: a prospective clinical and neuropsychological study of whiplash injury.J Neurol Neurosurg Psychiatry 1992; 55: 943–948.

    PubMed  Google Scholar 

  21. How A, Dent PB, Liao SK, Denburg JA. Antineuronal antibodies in neuropsychiatric systemic lupus erythematosus.Arthritis Rheum 1985; 28: 789–795.

    PubMed  Google Scholar 

  22. Hamacher K, Coenen HH, Stöcklin G. Efficient stereospecific synthesis of no-carrier added 2-[18F]-fluoro-2-deoxy-d-glucose using aminopolyether supported nucleophilic substitution.J Nucl Med 1986; 27: 235–238.

    PubMed  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.

    PubMed  Google Scholar 

  26. Gonzalez-Crespo MR, Blanco FJ, Ramos A, Ciruelo E, Mateo I, Lopez-Pino MA, Gomez-Reino JJ. Magnetic resonance imaging of the brain in systemic lupus erythematosus.Br J Rheumatol 1995; 34: 1055–1060.

    PubMed  Google Scholar 

  27. Baum KA, Hopf U, Nehrig C, Stover M, Schomer W. Systemic lupus erythematosus: neuropsychiatric signs and symptoms related to cerebral MRI findings.Clin Neurol Neurosurg 1993; 95: 29–34.

    PubMed  Google 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 

  29. vanDam AP. Diagnosis of pathogenesis of CNS lupus.Rheumatol Int 1991; 11: 1–11.

    PubMed  Google Scholar 

  30. Mclnness PM, Schuttinga J, Sanslone WR, Stark SP, Klippel JH. The economic impact of treatment of severe lupus nephritis with prednisolone and cyclophosphamide.Arthritis Rheum 1994; 37: 1000–1006.

    PubMed  Google Scholar 

  31. Bruyn GA. Controversies in lupus: nervous system involvement.Ann Rheum Dis 1995; 54: 159–167.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Nuclear Medicine, University Hospital, Basel, Switzerland

    A. Otte, J. Mueller-Brand & M. Goetze

  2. Department of Rheumatology and Immunology, University Hospital Freiburg, Germany

    S. M. Weiner, H. H. Peter & J. Gutfleische

  3. Department of Nuclear Medicine, University Hospital Freiburg, Germany

    A. Otte, E. Moser, S. Hoegerle, F. D. Juengling & E. U. Nitzsche

Authors
  1. A. Otte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. M. Weiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. H. Peter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Mueller-Brand
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Goetze
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Moser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Gutfleische
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Hoegerle
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F. D. Juengling
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. U. Nitzsche
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Otte, A., Weiner, S.M., Peter, H.H. et al. Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: A controlled positron emission tomography study. Eur J Nucl Med 24, 787–791 (1997). https://doi.org/10.1007/BF00879668

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00879668

Key words

Search

Navigation