单光子发射计算机断层扫描在系统性红斑狼疮中枢神经系统病变中的诊断价值

目的 评价单光子发射计算机断层扫描(single photon emission computed tomography，SPECT)在系统性红斑狼疮中枢神经系统病变(CNS-SLE)诊断中的应用价值。方法 对21例SLE患者进行SPECT检查，并由2名以上经过训练且不知晓患者病情的核医学医师进行独立读片，明确脑血流灌注异常部位。对10例CNS-SLE患者同时行头颅CT和，或核磁共振(MRI)检查。结果 10例CNS-SLE中9例头颅SPECT阳性(阳性率90％)，同时行头颅CT／MRI检查仅4例阳性(阳性率40％)。9例均为中～重度血流灌注减低，9例均有额叶和，或顶叶受累(6例额叶受累，4例顶叶受累，5例基底节受累，1例颞叶受累，0例枕叶受累，7例为多个区域受累)。对其中3例CNS-SLE患者治疗前后SPECT表现进行比较，发现经有效治疗临床症状改善后，SPECT异常随之明显改善甚至完全消失。11例非CNS-SLE中，仅2例SPECT阳性(阳性率18％)，且均为轻度单一区域血流灌注减低(1例枕叶，1例基底节)，无一例有额叶或顶叶受累。结论 SPECT对于CNS-SLE是一种敏感的检测手段，对监测病情变化、指导治疗有重要的参考价值；SLE患者头颅SPECT表现多发病灶、有额叶和(或)顶叶受累及中～重度血流灌注减低提示有CNS受累。

Diagnostic value of single photon emission computed tomography in central nervous system involvement in systemic lupus erythematosus

Objective Central nervous system (CNS) involvement is a severe complication of systemic lupus erythematosus(SLE).Early diagnosis and treatment could significantly improve its prognosis.Traditional image methods such as CT and MRI are mostly static images with low sensitivity.This study evaluated the diagnostic value of single photon emission computed tomography(SPECT) in CNS-SLE.Method Twenty-one SLE patients,including 10 CNS-SLE and 11 non-CNS-SLE,underwent SPECT examination.The images were evaluated separately by two experienced physicians of nuclear medicine without previous knowledge of the cases.Ten CNS-SLE patients also underwent CT and/or MRI examination.Results SPECT abnormalities were detected in 9 of 10 CNS-SLE(90%) while only 4 of them (40%) were CT/MRI abnormal.SPECT images in all these 9 cases showed frontal and/or parietal lobe involvement manifested as moderate to severe perfusion defect (6 of frontal lobe,4 of parietal lobe,5 of basilar region,1 of temporal lobe,7 of multiple regions).In 3 CNS-SLE patients,repeated SPECT examinations showed perfusion defect improved significantly or even disappeared after effective treatment.In the 11 non-CNS-SLE patients,SPECT abnormalities were detected in only 2 cases(18%),and both were mild,involving single region and sparing frontal and parietal lobe.Conclusion SPECT is a sensitive method in detecting CNS-SLE,and is useful in monitoring disease severity and guiding treatment.Moderate to severe perfusion defect in SPECT involving multiple regions,especially frontal and/or parietal lobes in lupus patients suggests CNS involvement.