Kao C H, Lan J L, ChangLai S P, Liao K K, Yen R F, Chieng P U
Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Eur J Nucl Med. 1999 Feb;26(2):129-34. doi: 10.1007/s002590050368.
Involvement of the brain is one of the most important complications of systemic lupus erythematosus (SLE); however, its diagnosis is difficult due to the lack of effective imaging methods. We combined three brain imaging modalities - positron emission tomography with fluorine-18 2-fluoro-2-deoxy-d-glucose (FDG-PET), single-photon emission computed tomography with technetium-99m hexamethylpropylene amine oxime (HMPAO-SPET) and magnetic resonance imaging (MRI) - in order to detect brain involvement in SLE. Thirty-seven SLE patients, aged 22-45 years, were divided into three groups. Group 1 (G1) consisted of ten patients with major neuropsychiatric manifestations; group 2 (G2) consisted of 15 patients with minor manifestations; and group 3 (G3) consisted of 12 patients without manifestations. FDG-PET findings were abnormal in 51% of patients: 90% of G1, 67% of G2 and 0% of G3 patients respectively. HMPAO-SPET findings were abnormal in 62% of patients: 100% of G1, 73% of G2 and 17% of G3 patients respectively. MRI findings were abnormal in 35% of patients: 70% of G1, 40% of G2 and 0% of G3 patients respectively. Grey matter was more commonly involved than white matter; 62% of patients presented with lesions in the cerebral cortex, 27% with lesions in the basal ganglion, 5% with lesions in the cerebellum, and 19% with lesions in white matter. No white matter lesions were found on FDG-PET or HMPAO-SPET. However, in 19% of patients, MRI demonstrated abnormally high signal lesions in white matter. Forty-three percent of cases had positive serum anticardiolipin antibodies (ACA). However, ACA was not related to FDG-PET, HMPAO-SPET or MRI findings. It may be concluding that HMPAO-SPET is a more sensitive tool for detecting brain involvement in SLE patients when compared with FDG-PET or MRI. However, MRI is necessary for detecting lesions in white matter.
脑部受累是系统性红斑狼疮（SLE）最重要的并发症之一；然而，由于缺乏有效的影像学方法，其诊断较为困难。我们将三种脑成像方式——氟-18 2-氟-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）、锝-99m六甲基丙烯胺肟单光子发射计算机断层扫描（HMPAO-SPET）和磁共振成像（MRI）——相结合，以检测SLE患者的脑部受累情况。37例年龄在22至45岁之间的SLE患者被分为三组。第1组（G1）由10例有主要神经精神表现的患者组成；第2组（G2）由15例有轻微表现的患者组成；第3组（G3）由12例无表现的患者组成。FDG-PET检查结果显示，51%的患者异常：G1组患者中90%、G2组患者中67%、G3组患者中0%。HMPAO-SPET检查结果显示，62%的患者异常：G1组患者中100%、G2组患者中73%、G3组患者中17%。MRI检查结果显示，35%的患者异常：G1组患者中70%、G2组患者中40%、G3组患者中0%。灰质比白质更常受累；62%的患者大脑皮层有病变，27%的患者基底节有病变，5%的患者小脑有病变以及19%的患者白质有病变。在FDG-PET或HMPAO-SPET上未发现白质病变。然而，19%的患者MRI显示白质有异常高信号病变。43%的病例血清抗心磷脂抗体（ACA）呈阳性。然而，ACA与FDG-PET、HMPAO-SPET或MRI检查结果无关。可以得出结论，与FDG-PET或MRI相比，HMPAO-SPET是检测SLE患者脑部受累更敏感的工具。然而，检测白质病变需要MRI。
