Lass P, Koseda M, Romanowicz G, Mechlińska J, Banecka Z, Góra M, Hebanowski M, Stepień E, Łyczak P
Department of Nuclear Medicine, Medical University, Gdańsk, Poland.
Nucl Med Rev Cent East Eur. 1998;1(1):20-4.
Cerebrovascular diseases are one of the most important complications of systemic lupus erythematosus (SLE). The diagnostic imaging of neuropsychiatric SLE complications presents many problems. This study was undertaken to investigate cerebral blood flow char s and its reactivity to hypercapnia by means of acetazolamide test in SLE patients.
Brain SPELT studies using 99mTc-HMPAO were performed in 50 patients with SLE. Acetazolamide test was performed in 35 patients 3 days after the baseline study by means of repetitive scanning 20 min after i.v. injection of 1.0 g of acetazolamide.
Significant interhemispheric hypoperfusion areas were shown in 76.3% of all patients, 83.8% symptomatic and 63.1 % asymptomatic. Patients with antiphospholipid syndrome showed multifocal perfusion deficits. The reaction of cerebral perfusion to acetazolamide was heterogenous and showed increase, decrease, no change or mixed reaction of baseline-study-found focal hypoperfusion. Acetazolamide test revealed hypoperfusion in two patients with normal baseline study. MRI scanning revealed cerebral lesions in 41 % of patients.
CBF asymmetries in symptomatic and asymptomatic patients with SLE are frequent. Regional CBF alterations seem to be different in patients with and without antiphospholipid syndrome. The part of the patients with SLE shows no or paradoxically inversed reaction to acetazolamide.
脑血管疾病是系统性红斑狼疮（SLE）最重要的并发症之一。神经精神性SLE并发症的诊断成像存在许多问题。本研究旨在通过乙酰唑胺试验研究SLE患者的脑血流特征及其对高碳酸血症的反应性。
对50例SLE患者进行了使用99mTc-HMPAO的脑单光子发射计算机断层扫描（SPECT）研究。在基线研究3天后，对35例患者进行乙酰唑胺试验，静脉注射1.0g乙酰唑胺20分钟后进行重复扫描。
所有患者中有76.3%显示出明显的半球间灌注不足区域，有症状者为83.8%，无症状者为63.1%。抗磷脂综合征患者表现为多灶性灌注缺损。脑灌注对乙酰唑胺的反应是异质性的，表现为增加、减少、无变化或对基线研究发现的局灶性灌注不足的混合反应。乙酰唑胺试验显示，两名基线研究正常的患者存在灌注不足。MRI扫描显示41%的患者有脑病变。
有症状和无症状的SLE患者中脑血流不对称很常见。有和没有抗磷脂综合征的患者区域脑血流改变似乎不同。部分SLE患者对乙酰唑胺无反应或反应呈反常性逆转。
