Single photon emission computed tomography and magnetic resonance imaging evaluation in SLE patients with and without neuropsychiatric involvement

Objective. To assess the relationship between clinical pictureand neuroimaging in patients affected by SLE with and withoutneuropsychiatric (NP) involvement. Methods. One hundred and seven SLE patients including 66 withNP involvement (NPSLE) with focal or diffuse presentation and41 without underwent single photon emission computed tomography(SPECT) and MRI. Results. After stratification for diffuse or focal NP involvement,in the 52 patients with diffuse presentation, abnormalitiesdetected with MRI or SPECT did not differ from patients withoutNP; however, after combining the two techniques, a normal resultwas more frequently observed in patients without NP involvement(P = 0.010). In the 14 patients with focal presentation, MRIalone and concordant abnormal MRI plus SPECT were more frequentlydetected in the NPSLE group; again normal findings by both techniquessimultaneously applied were more frequently found in SLE patientswithout NP involvement. White matter hyperintense T2-weightedlesions were the most frequent MRI abnormal findings in bothgroups, but the presence of multiple lesions (>5) involvingboth the hemispheres at subtentorial level was limited to NPSLEpatients. Multifocal hypoperfused SPECT areas were more frequentlyobserved in frontal and parietal lobes of NPSLE. Conclusions. Combining SPECT and MRI appears more useful thanthe two techniques alone and may help the clinician in the assessmentof patients with NP involvement since normal findings contemporarilydetected by these two techniques have been rarely observed inpatients with NP involvement especially in those with focalmanifestations where MRI and SPECT were never simultaneouslynormal. KEY WORDS: Systemic lupus erythematosus, Central nervous system, Magnetic resonance imaging, Single photon emission computed tomography Submitted 29 June 2007; revised version accepted 3 December 2007.