99mTc-HMPAO brain SPECT in the monitoring of cerebral vasculitis therapy

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018 Jul-Aug;37(4):211-217. doi: 10.1016/j.remn.2017.10.009. Epub 2018 Mar 28.
[Article in English, Spanish]

Abstract

Objective: The central nervous system (CNS) may be involved in a variety of inflammatory diseases of the blood vessels, generally known as vasculitis. The clinical diagnosis of such involvement in early stages is difficult, since a mild cognitive impairment can be the only symptom. It was hypothesized that brain-perfusion SPECT would be able to reveal CNS involvement and to monitor the course of the disease. The purpose of this study was assess if and when an improvement of cerebral perfusion can be registered by SPECT during the follow-up of these diseases.

Material and methods: Eighteen patients affected by Systemic Lupus Erythematosus (SLE), 22 by undifferentiated vasculitis (UV), 5 by Behcet's disease (BD) and 5 by primary Sjogren's Syndrome (pSS) were enrolled in this prospective study. A 99mTc-HMPAO brain perfusion SPECT was performed before the treatment and was repeated during the follow-up at different time intervals. Image analysis was performed on 10 cerebral areas using a specific software.

Results: In the SLE patients, no significant improvement of brain perfusion was found. On the contrary, in the UV the cerebral uptake of the tracer significantly improved from the twenty-fourth month (18/22 patients). Patients with BD showed an improvement of scintigraphic findings (5/5 patients), while a similar result was obtained only in 2 of the patients with pSS.

Conclusions: In conclusion, brain SPECT seems to be able to monitor the disease in UV, indicating the moment when an improvement of the cerebral perfusion is achieved. In SLE patients this scintigraphic technique did not show a significant improvement in CNS perfusion.

Keywords: Brain perfusion; Monitoring of therapy; Perfusión cerebral; SPECT; Seguimiento de la terapia; Vasculitis.

MeSH terms

  • Adrenal Cortex Hormones / pharmacology
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Behcet Syndrome / complications
  • Behcet Syndrome / drug therapy
  • Brain / blood supply
  • Brain / diagnostic imaging*
  • Cerebrovascular Circulation / drug effects
  • Cognition Disorders / drug therapy
  • Cognition Disorders / etiology
  • Drug Monitoring
  • Female
  • Humans
  • Immunosuppressive Agents / pharmacology
  • Immunosuppressive Agents / therapeutic use
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / drug therapy
  • Male
  • Neuroimaging / methods*
  • Neuropsychological Tests
  • Prospective Studies
  • Radiopharmaceuticals / pharmacokinetics*
  • Sjogren's Syndrome / complications
  • Sjogren's Syndrome / drug therapy
  • Technetium Tc 99m Exametazime / pharmacokinetics*
  • Tomography, Emission-Computed, Single-Photon / methods*
  • Treatment Outcome
  • Vasculitis, Central Nervous System / diagnostic imaging*
  • Vasculitis, Central Nervous System / drug therapy
  • Vasculitis, Central Nervous System / etiology
  • Vasculitis, Central Nervous System / psychology

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents
  • Radiopharmaceuticals
  • Technetium Tc 99m Exametazime