Trevisan Ana Carolina, Alexandre-Santos Leonardo, Assad Rodrigo Luppino, Itikawa Emerson Nobuyuki, Pitella Felipe Arriva, Kato Mery, Silvah José Henrique, Santos Antonio Carlos, Louzada-Junior Paulo, Wichert-Ana Lauro
Nuclear Medicine and PET/CT Laboratory. Ribeirão Preto Medical School, Post Graduate Program in Internal Medicine, University of São Paulo, Ribeirão Preto, Brazil.
Inter-units Bioengineering Postgraduate Program, University of São Paulo, São Carlos School of Engineering / USP, São Carlos, SP, Brazil.
Eur J Hybrid Imaging. 2021 Nov 4;5(1):19. doi: 10.1186/s41824-021-00112-3.
This study was addressed to evaluate the temporal and spatial changes in regional cerebral blood flow (rCBF) of patients with neuropsychiatric systemic lupus erythematosus (NPSLE). Our objective was to correlate the subtracted SPECT coregistered to MRI features (SISCOM) with demographic, clinical and laboratory findings to shed light upon the pathophysiological evolution of the NPSLE. Twenty-six NPSLE patients with MRI and pre- and post-treatment brain SPECT with [99mTc]Tc-ECD. SISCOM features were categorized as improvement, worsening, activation and/or deactivation of rCBF findings. Patients mean age of 43.19 years and 65.38% white were evaluated. The patients mean age at onset of SLE was 26.05 and 42.29 for NPSLE. The mean time between the onset of SLE and first NPSLE symptoms was 05.57 years. The disease has already been initiated as NPSLE in 4 patients. The SLEDAI average score was 31.69 and the SLICC/ACR-DI score was 06.96. The patients underwent an average of 09.23 cyclophosphamide. The SISCOM findings showed functional and pathological states on different brain regions. The rCBF changes were not associated with index scores. There was, however, a trend towards an association between lower SLEDAI scores with improvement and higher SLEDAI with worsening in SISCOM, Also a trend of association between lower SLICC score with improvement, and higher SLICC with worsening. The female gender was predictive of activation and worsening, separately, and deactivation and worsening in a set. Non-white patients were predictive of worsening. The seizure was predictive of deactivation separately, and deactivation and worsening in a set. Finally, normal C3 was a predictor of improvement. The present study showed dynamic brain changes in NPSLE patients. SISCOM technique showed improved rCBF in some brain areas, and worsening, activation and deactivation in others. There were associations between rCBF changes and gender, skin colour and complement C3 and association trends with SLEDAI and SLICC scores.
本研究旨在评估神经精神性系统性红斑狼疮（NPSLE）患者局部脑血流（rCBF）的时空变化。我们的目标是将与MRI特征配准的减影单光子发射计算机断层扫描（SISCOM）与人口统计学、临床和实验室检查结果相关联，以阐明NPSLE的病理生理演变。26例NPSLE患者接受了MRI检查以及治疗前后的脑[99mTc]Tc-ECD单光子发射计算机断层扫描。SISCOM特征被分类为rCBF结果的改善、恶化、激活和/或失活。对平均年龄为43.19岁、65.38%为白人的患者进行了评估。患者的SLE平均发病年龄为26.05岁，NPSLE为42.29岁。SLE发病与首次出现NPSLE症状之间的平均时间为5.57年。4例患者起病即为NPSLE。SLEDAI平均评分为31.69，SLICC/ACR-DI评分为6.96。患者平均接受了9.23次环磷酰胺治疗。SISCOM结果显示不同脑区存在功能和病理状态。rCBF变化与指数评分无关。然而，在SISCOM中，较低的SLEDAI评分与改善相关，较高的SLEDAI评分与恶化相关，以及较低的SLICC评分与改善相关，较高的SLICC评分与恶化相关，存在一定趋势。女性性别分别预测激活和恶化，以及一组中的失活和恶化。非白人患者预测恶化。癫痫分别预测失活，以及一组中的失活和恶化。最后，正常的C3是改善的预测指标。本研究显示了NPSLE患者脑部的动态变化。SISCOM技术显示一些脑区的rCBF改善，而其他脑区则出现恶化、激活和失活。rCBF变化与性别、肤色和补体C3之间存在关联，与SLEDAI和SLICC评分存在关联趋势。
