Kovacs J A, Urowitz M B, Gladman D D, Zeman R
University of Toronto Lupus Clinic, Wellesley Hospital, Canada.
J Rheumatol. 1995 Jul;22(7):1247-53.
To test the sensitivity of single photon emission computerized tomography (SPECT) in detecting brain abnormalities in cases of definite active neuropsychiatric systemic lupus erythematosus (NPSLE) in a blinded, prospective pilot study.
Fourteen patients fulfilling at least 4 of the American College of Rheumatology criteria for the classification of SLE plus positive serology manifested by either elevated DNA binding or decreased serum complement and a recent neuropsychiatric event were evaluated with cerebral SPECT using hexa-methyl-propylene-amine-oxime labeled 99Tc. Secondary causes such as infection, uremia, hypertension, drugs, and metabolic abnormalities were excluded. Patients underwent brain scan and electroencephalogram (EEG) for comparison. When clinically indicated, CT scan, magnetic resonance imaging, angiography, and lumbar puncture were performed.
SPECT scan abnormalities were noted in 12/14 patients and brain scan was abnormal in 12/14 patients. SPECT and brain scan were in accordance in 12/14 patients (11 patients both positive and 1 both negative) and the combination of SPECT and brain scan yielded 13/14 positive results. In the 3 patients with headache, SPECT scan was negative in 2/3, despite positive EEG and one with a positive brain scan. The positive SPECT in the patient with headache showed an old cerebrovascular accident (CVA), which was confirmed by CT scan. The most consistent CT finding was cortical atrophy; however, SPECT identified a lesion in the occipital cortex in a patient with seizure, and a lesion in the basal ganglia in a patient with ataxia.
In clinically and serologically active NPSLE, SPECT is a sensitive diagnostic tool. When further stratifying NPSLE into focal (seizure, ataxia, CVA) and diffuse (headache, organic brain syndrome, psychosis), SPECT appeared to be sensitive for focal disease and for most diffuse manifestations, with the exception of headache. The high sensitivity of SPECT in patients with true, positive NPSLE merits further controlled studies in unselected patients with SLE.
在一项盲法前瞻性初步研究中，检测单光子发射计算机断层扫描（SPECT）对确诊的活动性神经精神性系统性红斑狼疮（NPSLE）患者脑异常的检测敏感性。
14例至少符合美国风湿病学会SLE分类标准中的4条，且血清学阳性（表现为DNA结合升高或血清补体降低）以及近期有神经精神事件的患者，使用六甲基丙烯胺肟标记的99Tc进行脑SPECT评估。排除感染、尿毒症、高血压、药物及代谢异常等继发原因。患者接受脑部扫描和脑电图（EEG）检查以作比较。根据临床指征，进行CT扫描、磁共振成像、血管造影和腰椎穿刺。
14例患者中12例SPECT扫描异常，12例脑部扫描异常。14例患者中12例SPECT与脑部扫描结果一致（11例均为阳性，1例均为阴性），SPECT与脑部扫描联合检测得到14例中的13例阳性结果。3例头痛患者中，2/3的SPECT扫描为阴性，尽管EEG阳性且1例脑部扫描阳性。头痛患者中SPECT阳性显示陈旧性脑血管意外（CVA），CT扫描证实。最常见的CT表现是皮质萎缩；然而，SPECT在1例癫痫患者的枕叶皮质发现1个病灶，在1例共济失调患者的基底节发现1个病灶。
在临床和血清学活动性NPSLE中，SPECT是一种敏感的诊断工具。当将NPSLE进一步分为局灶性（癫痫、共济失调、CVA）和弥漫性（头痛、器质性脑综合征、精神病）时，SPECT对局灶性疾病和大多数弥漫性表现似乎敏感，但头痛除外。SPECT在真正的阳性NPSLE患者中的高敏感性值得在未选择的SLE患者中进行进一步对照研究。
