title: Role of Brain Perfusion SPECT with 99mTc HMPAO in the Assessment of Response to Drug Therapy in Patients with Autoimmune Vasculitis: A Prospective Study.
abstract: BACKGROUND
  The diagnosis of vasculitis in the brain remains a quite difficult achievement. To the best of our knowledge, there is no imaging method reported in literature which is capable of reaching to a diagnosis of vasculitis with very high sensitivity.
  
  
  OBJECTIVE
  The aim of this study was to determine whether perfusion brain single photon emission computed tomography (SPECT) can be usefully employed in monitoring the treatment of vasculitis, allowing treating only potentially responder patients and avoiding the side effects on patients who do not respond.
  
  
  METHODS
  Twenty patients (two males and 18 females) suffering from systemic lupus erythematosus (SLE; n = 5), Behcet's disease (BD; n = 5), undifferentiated vasculitis (UV; n = 5), and Sjogren's syndrome (SS; n = 5) were included in the study. All patients underwent a wide neurological anamnestic investigation, a complete objective neurological examination and SPECT of the brain with 99mTc-hexamethyl-propylene-aminoxime (HMPAO). The brain SPECT was then repeated after appropriate medical treatment. The neurological and neuropsychiatric follow-up was performed at 6 months after the start of the treatment.
  
  
  RESULTS
  Overall, the differences between the scintigraphic results obtained after and before the medical treatment indicated a statistically significant increase of the cerebral perfusion (CP). In 19 out of 200 regions of interest (ROI) studied, the difference between pre- and post treatment percentages had negative sign, indicating a worsening of CP. This latter event has occurred six times (five in the same patients) in the UV, 10 times (eight in the same patients) in the SLE, never in BD, and three times (two in the same patient) in the SS.
  
  
  CONCLUSIONS
  The reported results seem to indicate the possibility of identifying, by the means of a brain SPECT, responder and nonresponder (unchanged or worsened CP) patients, affected by autoimmune vasculitis, to the therapy.
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome "Sapienza", Rome, Italy.
authors.forename: Liberatore
authors.initials: L
authors.lastname: Mauro
authors.affiliation: Department of Medical and Surgical Sciences and Biotechnologies, Section of Neurology, Neuropsychology Outpatients Service, University of Rome "Sapienza", Rome, Italy.
authors.forename: Morreale
authors.initials: M
authors.lastname: Manuela
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome "Sapienza", Rome, Italy.
authors.forename: Megna
authors.initials: M
authors.lastname: Valentina
authors.affiliation: Department of Neurology and Psychiatry, University of Rome "Sapienza", Rome, Italy.
authors.forename: Collorone
authors.initials: C
authors.lastname: Sara
authors.affiliation: Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Chondrogiannis
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome "Sapienza", Rome, Italy.
authors.forename: Drudi Francesco
authors.initials: DF
authors.lastname: Maria
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome "Sapienza", Rome, Italy.
authors.forename: Anagnostou
authors.initials: A
authors.lastname: Christos
authors.affiliation: Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome "Sapienza", Rome, Italy.
authors.forename: Civitelli
authors.initials: C
authors.lastname: Liana
authors.affiliation: Department of Neurology and Psychiatry, University of Rome "Sapienza", Rome, Italy.
authors.forename: Francia
authors.initials: F
authors.lastname: Ada
authors.affiliation: Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Anna Margherita
authors.initials: AM
authors.lastname: Maffione
authors.affiliation: Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marzola
authors.affiliation: Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
keywords: Autoimmune vasculitis; HMPAO; SPECT; brain perfusion; central nervous system; therapy