Skip to main content
SpringerLink
Log in

Early and delayed Tc-99m ECD brain SPECT in SLE patients with CNS involvement

  • Original Articles
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

We compared early and delayed Tc-99m ECD SPECT scans in 32 SLE patients (Group 1, definite neuropsychiatric disorders; Group 2, minor neurologic symptoms or normal) with those of normal controls by visual inspection and semi-quantitative evaluation. With visual interpretation, 13 out of 14 patients in Group 1 (93%) and 7 out of 18 patients in Group 2 (39%) had diffuse uneven decrease in early scans. Seven patients in Group 2 (39%) who had normal early scans demonstrated focal decrease in the medial frontal lobe in delayed scans. With cerebral region to cerebellar ratios, in early scans, the medial frontal lobe in Group 1 and Group 2 was significantly lower than in normal controls, and lateral frontal lobe and occipital lobes in Group 1 were significantly lower than in normal controls. Nevertheless, in delayed scans, every cortical region except for the parietal lobe in Groups 1 and 2 was significantly lower than in normal controls. The retention rates in all regions in SLE patients were significantly lower than in normal controls. No case showed SPECT improvement on follow-up studies in either group in spite of clinical improvement. Delayed Tc-99m ECD brain SPECT of high sensitivity might be useful in detecting CNS involvement. Although the SPECT findings did not correlate with the neuropsychiatric symptoms, early and delayed Tc-99m ECD SPECT seems to provide useful objective diagnostic information in SLE patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bruyn GAW. Controversies in lupus: nervous system involvement.Ann Rheum Dis 54: 159–167, 1995.

    Article  PubMed  CAS  Google Scholar 

  2. Williams DG, Mitehell I, Webb M, Hughes RAC, Maisey M, Cameron S. Cerebral lupus.Lancet i: 579–582, 1994.

    Google Scholar 

  3. Hirohata S, Hirose S, Miyamoto T. Cerebrospinal fluid IgM, IgA, and IgG indexes in systemic lupus erythematosus — Their use as estimates of central nervous system disease activity.Arch Intern Med 145: 1843–1846, 1985.

    Article  PubMed  CAS  Google Scholar 

  4. Hirohata S, Miyamoto T. Elevated levels of interleukin-6 in cerebrospinal fluid from patients with systemic lupus erythematosus and central nervous system involvement.Arthritis Rheum 33: 644–649, 1990.

    Article  PubMed  CAS  Google Scholar 

  5. Shiozawa S, Kuroki Y, Kim M, Hirohata S, Ogino T. Interferon-alpha in lupus psychosis.Arthritis Rheum 35: 417–422, 1992.

    Article  PubMed  CAS  Google Scholar 

  6. Rubbert A, Marienhagen J, Pirner K, Manger B, Grebmeier J, Engelhardt A, et al. Single-photon-emission computed tomography analysis of cerebral blood flow in the evaluation of central nervous system involvement in patients with systemic lupus erythematosus.Arthritis Rheum 36: 1253–1262, 1993.

    Article  PubMed  CAS  Google Scholar 

  7. Nossent JC, Hovestadt A, Schönfeld DHW, Swaak AJG. Single-photon-emission computed tomography of the brain in the evaluation of cerebral lupus.Arthritis Rheum 34: 1397–1403, 1991.

    PubMed  CAS  Google Scholar 

  8. Lin WY, Wang SJ, Yen TC, Lan JL. Technetium-99m HMPAO brain SPECT in systemic lupus erythematosus with CNS involvement.J Nucl Med 38: 1112–1115, 1997.

    PubMed  CAS  Google Scholar 

  9. Colamussi P, Giganti M, Cittanti C, Dovigo L, Trotta F, Tola MR, et al. Brain single-photon emission tomography with Tc-99m HMPAO in neuropsychiatric systemic lupus erythematosus: relations with EEG and MRI findings and clinical manifestations.Eur J Nucl Med 22: 17–24, 1995.

    Article  PubMed  CAS  Google Scholar 

  10. Grünwald F, Schomburg A, Badali A, Ruhlmann J, Pavics L, Biersack HJ. F-18 DG PET and acetazolamide-enhanced Tc-99m HMPAO SPET in systemic lupus erythematosus.Eur J Nucl Med 22: 1073–1077, 1995.

    Article  PubMed  Google Scholar 

  11. Otte A, Weiner SM, Peter HH, Mueller-Brand J, Goetze M, Moser E, et al. Brain glucose utilization in systemic lupus erythematosus with neuropsychiatric symptoms: a controlled positron emission tomography study.Eur J Nucl Med 24: 787–791, 1997.

    PubMed  CAS  Google Scholar 

  12. Vermess M, Bernstein RM, Bydder GM, Steiner RE, Young IR, Hughes GRV. Nuclear magnetic resonance (NMR) imaging of the brain in systemic lupus erythematosus.J Comput Assist Tomogr 7: 461–467, 1983.

    Article  PubMed  CAS  Google Scholar 

  13. Mccune WJ, Macguire A, Aisen A, Gebarski S. Identification of brain lesions in neuropsychiatric systemic lupus erythematosus by magnetic resonance scanning.Arthritis Rheum 31: 159–166, 1988.

    Article  PubMed  CAS  Google Scholar 

  14. Ishikawa O, Ohnishi K, Miyachi Y, Ishizawa H. Cerebral lesions in systemic lupus erythematosus detected by magnetic resonance imaging. Relationship to anticardiolipin antibody.J Rheumatol 21: 87–90, 1994.

    PubMed  CAS  Google Scholar 

  15. Xiu Y, Sun XG, Chen SL. Detecting SLE brain involvement using SPECT cerebral blood flow perfusion imaging.Eur J Nucl Med 25: 864, 1998.

    Google Scholar 

  16. Kikukawa K, Toyama H, Katayama M, Nishimura T, Ejiri K, Fujii N, et al. Early and delayed Tc-99m ECD SPECT in SLE patients with and without CNS involvement.Eur J Nucl Med 25: 1073, 1998.

    Google Scholar 

  17. Ejiri K, Toyama H, Kato Y, Narita T, Takeshita G, Takeuchi A, et al. Evaluation of the system performance and clinical images of the single photon emission computed tomography for head using arranged detector.Radioisotopes 37: 37–40, 1988.

    Google Scholar 

  18. Kanno I, Uemura K, Miura S, Miura Y. HEADTOME: a hybrid emission tomograph for single photon and positron emission imaging of the brain.J Comput Assist Tomogr 5: 216–226, 1981.

    Article  PubMed  CAS  Google Scholar 

  19. Talairach J, Tournoux P, Rayport M. Co-planar stereotaxic atlas of the human brain. Three-dimensional proportional system: an approach to cerebral imaging. New York, Thieme Inc., pp. 1–122, 1988.

    Google Scholar 

  20. Flores II LG, Jinnouchi S, Nagamachi S, Ohnishi T, Futami S, Nakahara H, et al. Retention of Tc-99m ECD in delayed SPECT of the brain.Ann Nucl Med 13: 1–4, 1999.

    Article  PubMed  Google Scholar 

  21. Lass P, Koseda M, Lyczak P. Technetium-99m HMPAO brain SPECT in systemic lupus erythematosus with central nervous system involvement (Letter to the Editor).J Nucl Med 39: 930, 1998.

    PubMed  CAS  Google Scholar 

  22. Matsuda H, Yagishita A, Tsuji S, Hisada K. A quantitative approach to Tc-99m ethyl cysteinate dimer: A comparison with Tc-99m hexamethylpropylene amine oxime.Eur J Nucl Med 22: 633–637, 1995.

    Article  PubMed  CAS  Google Scholar 

  23. Kogure D, Matsuda H, Ohnishi T, Kunihiro T, Uno M, Asada T, et al. Longitudinal evaluation of early dementia of Alzheimer type using brain perfusion SPECT.KAKUIGAKU (Jpn J Nucl Med) 36: 91–101, 1999.

    CAS  Google Scholar 

  24. Mayberg HS, Lewis PJ, Regenold W, Wagner HN. Paralimbic hypoperfusion in unipolar depression.J Nucl Med 35: 929–934, 1994.

    PubMed  CAS  Google Scholar 

  25. Ichise M, Golan H, Ballinger JR, Vines D, Blackman A, Moldofsky H. Regional differences in Tc-99m ECD clearance on brain SPECT in healthy subjects.J Nucl Med 38: 1253–1260, 1997.

    PubMed  CAS  Google Scholar 

  26. Friberg L, Andersen AR, Lassen NA, Holm S, Dam M. Retention of Tc-99m bicisate in the human brain after intracarotid injection.J Cereb Blood Flow Metab 14 (Suppl 1): S19-S27, 1994.

    PubMed  CAS  Google Scholar 

  27. Ishizu K, Yonekura Y, Magata Y, Okazawa H, Fukuyama H, Tanaka F, et al. Extraction and retention of Tc-99m ECD in human brain: Dynamic SPECT and oxygen-15 water PET studies.J Nucl Med 37: 1600–1604, 1996.

    PubMed  CAS  Google Scholar 

  28. Tamgac F, Moretti JC, Defer G, Weinmann P, Roussi A, Casaro P. Non-matched images with I-123 IMP and Tc-99m bicisate single-photon emission tomography in the demonstration of focal hyperemia during the subacute phase of an ischemic stroke.Eur J Nucl Med 21: 254–257, 1994.

    Article  PubMed  CAS  Google Scholar 

  29. Nakagawara J, Nakamura J, Takeda R, Okumura T, Seki T, Hatase K, et al. Assessment of postischemic reperfusion and diamox activation test in stroke using Tc-99m ECD SPECT.J Cereb Blood Flow Metab 14 (Suppl 1): S49-S57, 1994.

    PubMed  Google Scholar 

  30. Shishido F, Uemura K, Murakami M, Inugami A, Ogawa T, Fujita H, et al. Cerebral uptake of Tc-99m bicisate in patients with cerebrovascular disease in comparison with CBF and CMRO2 measured by positron emission tomography.J Cereb Blood Flow Metab 14 (Suppl 1): S66-S75, 1994.

    PubMed  Google Scholar 

  31. Ogasawara K, Fujiwara S, Yoshimoto T. Tc-99m ECD dynamic SPECT in “luxury perfusion” of subacute stroke.KAKU IGAKU (Jpn J Nucl Med) 32: 1241–1247, 1995.

    CAS  Google Scholar 

  32. Komatani A, Sugai Y, Watanabe N, Yamaguchi K, Kawakatsu S. Discrepancy between Tc-99m HM-PAO and Tc-99m ECD in Alzheimer's disease: Does the retention mechanism depend on the disease?KAKU IGAKU (Jpn J Nucl Med) 35: 715–720, 1998.

    CAS  Google Scholar 

  33. Rieck H, Adelwöhrer C, Lungenschmid K, Deisenhammer E. Discordance of Tc-99m HMPAO and Tc-99m ECD SPECT in herpes simplex encephalitis.J Nucl Med 39: 1508–1510, 1998.

    PubMed  CAS  Google Scholar 

  34. Jacquier-Sparlin MR, Palla BS, Slosman DO. Cellular basis of ECD brain retention.J Nucl Med 37: 1694–1697, 1996.

    Google Scholar 

  35. Inoue Y, Momose T, Ohtake T, Nishikawa J, Sasaki Y, Waritani T, et al. Metabolism of Tc-99m-L,L ethyl cysteinate dimer in rat and cynomolgus monkey tissue.J Nucl Med 38: 1733–1737, 1997.

    Google Scholar 

  36. Szer IS, Miller JH, Rawlings D, Shaham B, Bernstein B. Cerebral perfusion abnormalities in children with central nervous system manifestations of lupus detected by single photon emission computed tomography.J Rheumatol 20: 2143–2148, 1993.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Fujita Health University, 1-98, Dengakugakubo, Kutsukake, 470-1192, Toyoake, Aichi, Japan

    Kaoru Kikukawa, Hiroshi Toyama, Tetsuhiro Nishimura, Kazutaka Ejiri, Kazuyuki Minami, Yutaka Emoto, Hisato Maeda, Kohei Senda, Akira Takeuchi & Sukehiko Koga

  2. Department of Rheumatology, Fujita Health University, 1-98, Dengakugakubo, Kutsukake, 470-1192, Toyoake, Aichi, Japan

    Masao Katayama, Hitomi Miyama, Hisaji Oshima, Shunji Yoshida & Katsutaka Torikai

  3. Department of Radiology, Mie University, Mie, Japan

    Kaname Matsumura

Authors
  1. Kaoru Kikukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Toyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masao Katayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsuhiro Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazutaka Ejiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazuyuki Minami
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kaname Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hitomi Miyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yutaka Emoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hisato Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kohei Senda
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Akira Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hisaji Oshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Shunji Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Katsutaka Torikai
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Sukehiko Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroshi Toyama.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kikukawa, K., Toyama, H., Katayama, M. et al. Early and delayed Tc-99m ECD brain SPECT in SLE patients with CNS involvement. Ann Nucl Med 14, 25–32 (2000). https://doi.org/10.1007/BF02990475

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02990475

Key words

Search

Navigation