Abnormal regional cerebral blood flow in systemic lupus erythematosus patients with psychiatric symptoms.
OBJECTIVE
Single-photon emission computed tomography (SPECT) studies have demonstrated decreased regional cerebral blood flow (rCBF) in systemic lupus erythematosus (SLE) patients. However, no study has done voxel-based analysis using statistical parametric mapping (SPM) that can evaluate rCBF objectively, and the relationship between rCBF and psychiatric symptoms has not been well investigated. Using L,L-ethyl cysteinate dimer (99mTc ECD) SPECT and SPM, we aimed to clarify the association of rCBF changes with psychiatric symptoms in SLE patients whose magnetic resonance imaging (MRI) showed no morphological abnormalities.


METHODS
Twenty SLE patients and 19 healthy volunteers underwent 99mTc ECD SPECT. Data were collected from August 2000 to March 2003. SLE was diagnosed according to American College of Rheumatology criteria, and psychiatric symptoms were diagnosed according to ICD-10 criteria. On the basis of the modified Carbotte, Denburg, and Denburg method, the patients were classified into 3 groups: a group with major psychiatric symptoms (hallucinosis, delusional disorder, and mood disorder), a group with minor psychiatric symptoms (anxiety disorder, dissociative disorder, and emotionally labile disorder), and a group without psychiatric symptoms. Gross organic lesions were ruled out by brain MRI. Group comparisons of rCBF were performed with analysis using SPM99.


RESULTS
SLE patients without MRI lesions showed decreased rCBF in the posterior cingulate gyrus and thalamus. The reduction in rCBF was overt in patients with major psychiatric symptoms.


CONCLUSIONS
Our study indicated that SLE patients may have dysfunction in the posterior cingulate gyrus and thalamus and that this may be associated with the severity of psychiatric symptoms.
Oda
Kenji
K
Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan.
Matsushima
Eisuke
E
Okubo
Yoshiro
Y
Ohta
Katsuya
K
Murata
Yuji
Y
Koike
Ryuji
R
Miyasaka
Nobuyuki
N
Kato
Motoichiro
M
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001931:Brain Mapping / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003545:Cysteine / Q000031:analogs & derivatives; D005260:Female; D006179:Gyrus Cinguli / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D038801:International Classification of Diseases; D008180:Lupus Erythematosus, Systemic / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D015609:Organotechnetium Compounds; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D013788:Thalamus / Q000098:blood supply* / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*
D015609:Organotechnetium Compounds; C059659:technetium Tc 99m bicisate; D003545:Cysteine