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Brain functional involvement by perfusion SPECT in systemic sclerosis and Behçet's disease
1Clinical Neurophysiology Division, Department of Internal Medicine, University of Genova, Genova, Italy. fnobili@smartino.ge.it
Annals of the New York Academy of Sciences
|July 13, 2002
Summary
Single photon emission computed tomography (SPECT) effectively detects central nervous system involvement in systemic immune-mediated diseases. This brain imaging technique revealed functional deficits in patients with Behçet
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Central nervous system (CNS) involvement is common in systemic immune-mediated diseases like systemic lupus erythematosus, Behçet's disease (BD), and systemic sclerosis (SSc).
- Conventional structural brain imaging (CT, MRI) is often inconclusive for diagnosing or monitoring these neurological complications.
- Subtle neurological symptoms may not be apparent in patients with these systemic conditions.
Purpose of the Study:
- To evaluate the utility of single photon emission computed tomography (SPECT) with perfusion tracers in detecting brain involvement in patients with systemic sclerosis (SSc) and Behçet's disease (BD).
- To assess the sensitivity of SPECT in identifying cerebral functional deficits, particularly in neurologically asymptomatic or subtly symptomatic patients.
Main Methods:
- SPECT imaging using perfusion tracers was performed on 42 neurologically asymptomatic patients with SSc and 8 neurologically symptomatic patients with BD.
- SPECT assesses regional cerebral blood flow, which reflects neuronal metabolic activity and can indicate hypoperfusion due to ischemia or neuronal damage.
- Findings were correlated with clinical presentation and results from structural brain examinations.
Main Results:
- SPECT demonstrated high sensitivity in detecting brain functional deficits.
- Approximately 50% of SSc patients without neurological complaints showed SPECT-detected brain deficits.
- All symptomatic BD patients exhibited SPECT-detected brain abnormalities, despite often inconclusive structural imaging.
Conclusions:
- SPECT is a powerful tool for revealing CNS involvement in systemic immune-mediated diseases, even with minimal or no neurological symptoms.
- SPECT imaging can identify regional hypoperfusion, indicative of neuronal metabolic derangement or ischemia, which is crucial for early diagnosis and management.
- This functional imaging technique offers significant advantages over structural imaging in cases of suspected cerebral involvement in SSc and BD.