Role of Brain Perfusion SPECT in the Assessment OF Neuropsychiatric Systemic Lupus Erythematosus

Document Type : Original Article

Author

Professor of Nuclear Medicine, National Cancer Institute, Cairo University.

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease with a broad variety of clinical manifestations, particularly affecting the kidneys and the central nervous system (NPSLE). In SLE, CNS manifestations have been described in 18- 61% of patients which have a strong impact on morbidity and mortality. In patients with NPSLE, clinical signs and symptoms are focal in 25% and diffuse in the remaining patients. CT or MRI are useful in the detection of focal neurological deficits rather than diffuse presentations. Brain perfusion SPECT is a functional, noninvasive imaging modality. for many neurological and psychiatric conditions, used in diagnosis, prognosis assessment, evaluation of response to therapy, risk stratification, and choice of medical or surgical therapy. The aim of
this study is the assessment of NPSLE using Tc-99m HMPAO brain perfusion SPECT. Patients & Methods: This study was carried out on twenty patients with SLE. The patients were classified into two groups: Group1: Patients without neuropsychiatricmanifestations(5 patients).
Group 2: Patients with neuropsychiatric manifestations (15 patients) who have one or more of the CNS syndromes observed in SLE according to the American college of Rheumatology. All patients performed brain perfusion SPECT which was interpreted for focal or diffuse perfusion defects. Results: Five patients (25%) showed normal SPECT study while fifteen patients (75%) had positive findings (perfusion defects). Ten patients (66.6 %) had diffuse perfusion defects, while the other five patients (33.4 %) had focal perfusion defects patients the most common site of hypoperfusion was the parietal lobe. Conclusion: Brain Perfusion SPECT is a sensitive non invasive diagnostic imaging modality for detection of cerebral blood flow abnormalities in SLE patients, reflecting sequelae of vasculitis. It is also useful in evaluating CNS involvement in patients with minor neuropsychiatric manifestationswith significant correlation between SPECT findings and disease activity.

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