title: Detection of myocardial involvement in systemic lupus erythematosus: mismatch between normal perfusion scans with 201Thallium and pathological 18FDG uptake.
abstract: BACKGROUND
  Systemic lupus erythematosus (SLE) patients can frequently present cardiac symptoms, however its etiology is not well known.
  
  
  METHODS
  
  
  
  METHODS
  prospective study.
  
  
  METHODS
  specialized out-patient unit for SLE patients at an university hospital.
  
  
  METHODS
  15 SLE patients (13 females, 2 males; age range 18-64 years).
  
  
  METHODS
  metabolic studies of the heart were done using 18F-deoxy-glucose (18FDG, 296-333 MBq on a 2-head hybrid system) as well as heart perfusion studies (111MBq 201Tl). Additional studies: resting ECG, echocardiography, stress ECG, immunological activity parameters, antibody analyses (ANA, ENA, anti-cardiolipin antibodies), CPK, troponin-T, and lipid profiles.
  
  
  METHODS
  degree of correlation between conventional diagnostics and the imaging techniques.
  
  
  RESULTS
  Abnormal ECG in 10 cases, pericardial involvement in 11 cases, elevated CPK in 1 case. ANTIBODY PROFILES: anti-cardiolipin in 10/15, ENA in 9/15, ANA in 14/15. None of these changes were associated with parameters of immune activation. In the majority of cases (10/15) the 18FDG scan showed a speckled, inhomogeneous pattern of distribution, which contrasted sharply with a normal 201Tl scan. A similar pattern was observed in the patients with ocular mitochondrial myopathy, the anti-phospholipid syndrome as well as in dermatomyositis.
  
  
  CONCLUSIONS
  Our preliminary results suggest that SLE patients with cardiac symptoms may have an abnormal glucose metabolism of the myocardium as shown by a pathological 18FDG scan, whereas perfusion appears to be normal (reversed mismatch). The lack of correlation with acute elevation of cardiac enzymes or with ECG changes suggest a chronic process.
authors.affiliation: Department of Nuclear Medicine, University of Innsbruck, Innsbruck, Austria. Roy.Moncayo@uibk.ac.at
authors.forename: R
authors.initials: R
authors.lastname: Moncayo
authors.forename: E
authors.initials: E
authors.lastname: Kowald
authors.forename: N
authors.initials: N
authors.lastname: Schauer
authors.forename: O
authors.initials: O
authors.lastname: Pachinger
authors.forename: M
authors.initials: M
authors.lastname: Schmuth
authors.forename: P
authors.initials: P
authors.lastname: Fritsch
authors.forename: G
authors.initials: G
authors.lastname: Riccabona
authors.forename: N
authors.initials: N
authors.lastname: Sepp
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012016:Reference Values; D013794:Thallium Radioisotopes; D014055:Tomography, Emission-Computed
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D019788:Fluorodeoxyglucose F18