Clinical Study Of Regional Cerebral Blood Flow SPECT Imaging For Neuropsychiatric In Systemic Lupus Erythematosus Patients

objective: To observe the changes of regional cerebral blood flow(rCBF) of neuropsychiatric in systemic lupus erythematosus(SLE) and evaluate the value of SPECT rCBF imaging in the detection of neuropsychiatric in SLE patients.Methods: 30 neuropsychiatric SLE patients were enrolled in the study and assigned to 2groups. Group 1 consisted of 20 patients with major neuropsychiatric manifestations (Major), 10 cases and 4 cases among which were performed brain computed tomogram(CT) and magnetic resonance imaging(MRI), respectively.Group 2 consisted of 10 patients with minor neuropsychiatric manifestations(Minor), 4 patients and 1 patients among which were perfomed brain CT and MRI scans, respectively. All neuropsychiatric SLE patients were performed SPECT rCBF imaging. 18 SLE patients without neuropsychiatric manifestations (SLE) and 10 healthy volunteers also underwent SPECT rCBF imaging for control. Semiquantitive analysis were engaged by selecting 3 connective cross-sections and delineating ROI(4x4pixel), which obtained HQ compared with SLE and healthy volunteers subjects. Plasma levels of Endothelin(ET) of all subjects were measured . After had been received during 2 months treatments, 10 neuropsychiatric SLE patients were underwent SPECT rCBF imaging again. According to the rCBF imaging ,the results and HQ of focus compared with that in the fist rCBF imaging.ResuIts:(1)SPECT finding were abnormal in 28(93.3%) of the 30 neuropsychiatric SLE patients. 27 of the 28 with abnormal SPECT findings showed focal uptake defects; another patient showed focalIVuptake increase. 17 of 18 patients without neuropsychiatric manifestations had normal SPECT findings, the 1(5.6%) remaining patient showed focal uptake defect. SPECT finding were all normal in 10 healthy volunteers. Temporal cortex were the most commonly involved regions,followed by frontal cortex and parietal regions. Thalamus, basal ganglion and white matter were rarely found. Cerebella were no found abnormality. Specific valves resulted from semiquantitive analysis(HQ) of frontal and temporal region in neruopsychiatric SLE patients were lower than that in healthy volunteers (P<0.05 and P<0.01, respectively). Specific valves resulted from semiquantitive analysis of each region in SLE patient without neuropsychiatric had no clear difference with that in healthy volunteers(P>0.05).(2) 3 patients(15.8%) among 19 neuropsychiatric SLE patients performed brain CT or MRI scans found the abnormality. The sensitivity of rCBF imaging and CT/MRI brain scans was 93.3% and 15.8%. Compared with the methods of rCBF imaging and CT/MRI, there were significantly difference(P<0.01).㏕he level of ET in the plasma of neuropsychiatric SLE patients was significantly higher than that in the healthy voluteers(P<0.01) and was not difference compared with that in SLE patients(P>0.05). However, the levels of ET in neuropsychiatric SLE patients with major and minor manifestations were no difference with that in SLE patients without neuropsychiatric manifestations(P>0.05).(4)After had been received treatments, 10 neuropsychiatric SLE patients came back to the hospital for reexamining SPECT rCBF imaging in 1 or 2 months. 10 neuropsychiatric SLE patients had no found new focus from the results of the second rCBF imaging. Compared with thepreceding imaging, 9 of 10 neuropsychiatric SLE patients were found that their brain blood flow significantly increased. The 1 remaining patients had no significantly changed. According to semiquantitive analysis, the HQ of the left and right temporal regions were significantly higher than that in the no treatment(P<0.01).The left front cortx, right parietal and right occipital region were higher than that in the no treatment(P<0.05).Conclusion: (1) SPECT rCBF imaging represents a senitive tool to detect the neuropsychiatric manifestations in SLE patients and have important valve to helpful for clinical diagnosis and therapy.The most changes of rCBF in neuropsychiatric SLE patients are regional cerebral blood flow hypoperfusion. (2)Hy...