Download PDF
Nuklearmedizin 1989; 28(05): 187-192
DOI: 10.1055/s-0038-1629490
Orticle Articles
Schattauer GmbH

Einsatz der FDG-PET bei der Diagnostik des zentralnervösen Lupus erythematodes und Vergleich mit CT und MRI[*]

FDG-PET in the Diagnosis of Neuropsychiatric Lupus erythematosus and Comparison with Computed Tomography and Magnetic Resonance Imaging
Gabriele Stoppe
1   Aus der Neurologischen Klinik mit klinischer Neurophysiologie (Prof. Dr. med. H. Künkel), Medizinische Hochschule Hannover, Münster, BRD
,
K. Wildhagen
2   der Abteilung Immunologie und Transfusionsmedizin (Prof. Dr. med. H. Deicher), Medizinische Hochschule Hannover, Münster, BRD
,
G. J. Meyer
3   der Abteilung Nuklearmedizin (Prof. Dr. med. Dr. h. c. H. Hundeshagen), Medizinische Hochschule Hannover, Münster, BRD
,
O. Schober
4   der Klinik und Poliklinik für Nuklearmedizin Westfälische Wilhelms-Universität (Prof. Dr. med. Dr. rer. nat. O. Schober), Münster, BRD
› Author Affiliations
Further Information

Publication History

Eingegangen: 13 June 1989

Publication Date:
05 February 2018 (online)

    Permissions and Reprints

Central nervous system involvement has been found in 30-75% of all cases of systemic lupus erythematosus (SLE). Up to now, clinical diagnosis is difficult and there are no markers for disease activity. We have compared cranial computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) using fluorodesoxyglucose (FDG) in two cases. FDG-PET is shown to be the most sensitive method demonstrating even reversible deficits and a better correlation with other neurological findings. MRI seems to be more sensitive than CT. A survey of the literature concerning imaging methods in neuropsychiatric SLE is given. The special problem of neuronal desactivation by antineuronal activity is discussed.

Zusammenfassung

Die zentralnervöse Beteiligung ist beim systemischen Lupus erythematodes mit 30-75% ein häufiges Problem. Klinisch schwierig ist die spezifische Diagnostik und die Beurteilung der Krankheitsaktivität. An zwei exemplarischen Fällen werden kraniales Computertomogramm (CT), Kernspintomogramm (MRI) und Positronenemissionstomographie (PET) mit Fluordesoxyglukose (FDG) miteinander verglichen. Es wird gezeigt, daß letztere Methode weit sensibler ist, reversible Veränderungen aufzeigt und eine bessere Korrelation zu den übrigen klinischen Sachverhalten hat. Das MRI ist dem CT an Aussagekraft überlegen. Ein Überblick über die entsprechende Literatur wird gegeben. Auf die besondere Problematik des Nachweises neuronaler Desaktivierung durch sogenannte antineuronale Aktivität wird eingegangen.

* Herrn Prof. Dr. D. Emrich, Göngen, zum 60. Geburtstag.


 

  • LITERATUR

  • 1 Aiscn F P R, Gabriclscn T O, McCune W J. MR imaging of systcmic lupus erythematosus involving the brain. Am J Radiol 1985; 144: 1027-31.
    Google Scholar
  • 2 Bennahum D A, Messner R P, Shoop J D. Brain scan findings in central nervous system involvement by lupus erythematosus. Ann Intern Med 1974; 81: 763-5.
    CrossrefPubMedGoogle Scholar
  • 3 Bentson J, Reza M, Winter J, Wilson G. Steroids and apparent cerebral atrophy on computed tomography scans. J Comput Assist Tomogr 1978; 02: 16-23.
    CrossrefPubMedGoogle Scholar
  • 4 Bilaniuk L T, Patel S, Zimmerman R A. Computed tomography in systcmic lupus erythematosus. Radiology 1977; 124: 119-2.
    CrossrefPubMedGoogle Scholar
  • 5 Bluestein H G. Ncurocytotoxic antibodies in serum of patients with systemic lupus erythematosus. Proc Natl Acad Sei (USA) 1978; 75: 3965-9.
    CrossrefPubMedGoogle Scholar
  • 6 Bluestein H G. Ncuropsychiatric manifestations of systcmic lupus erythematosus. N Engl J Med 1987; 317: 309-11.
    CrossrefPubMedGoogle Scholar
  • 7 Boey M L, Colaco C B, Gharavi A E. et al. Thrombosis in systemic lupus erythematosus: striking association with the presence of circulating lupus anticoagulant. Br Med J 1983; 28: 1021-3.
    Google Scholar
  • 8 Burke A J, Graham T, Kushner M. Regional cerebral blood flow in cerebral vasculitis. Neurology 1985; 33 (Suppl. 02) 205.
    Google Scholar
  • 9 Carette S, Urowitz M, Grossman H, St. Louis E. Cranial computerized tomography in systemic lupus erythematosus. J Rheumatol 1982; 09: 855-9.
    Google Scholar
  • 10 Denburg J A, Carbotte R M, Denburg S D. Neuronal antibodies and cognitive function in systemic lupus erythematosus. Neurology 1987; 37: 464-7.
    CrossrefPubMedGoogle Scholar
  • 11 Ellis S G, Verity M A. The central nervous system involvement in systemic lupus erythematosus. A review of neuropathologic findings in 57 cases, 1955-1977. Semin Arthritis Rheum 1979; 08: 212-21.
    Google Scholar
  • 12 Estes D, Christian CL. The natural history of systemic lupus erythematosus by prospective analysis. Medicine (Baltimore) 1971; 50: 85-95.
    CrossrefPubMedGoogle Scholar
  • 13 Feinglass E J, Arnett F C, Dorsch C A, Zizic Z M, Stevens M B. Neuropsychiatric manifestations of systemic lupus erythematosus: Diagnosis, clinical spectrum and relationship to other features of the diseaese. Medicine (Baltimore) 1976; 55: 323-39.
    CrossrefPubMedGoogle Scholar
  • 14 Funata N. Cerebral vascular changes in systemic lupus erythematosus. Bull Tokyo Med and Dent Univ 1979; 26: 91-112.
    Google Scholar
  • 15 Gibson T A, Myers R. Nervous system involvement in systemic lupus erythematosus. Ann Rheum Dis 1976; 35: 398-406.
    CrossrefPubMedGoogle Scholar
  • 16 Gonzalez-Scarano F, Lisak RP, Bilaniuk LT. et al. Cranial computed tomography in the diagnosis of systemic lupus erythematosus. Ann Neurol 1979; 05: 158-65.
    CrossrefPubMedGoogle Scholar
  • 17 Grisanti M A, Vergara F, Cartier L, Guzman L. Compromiso del sistema nervioso central debido a lupus eritematoso diseminado. Rev Med de Chile (Santiago) 1985; 113: 1194-202.
    Google Scholar
  • 18 Hadler N M, Gerwin R D, Frank M M. et al. The fourth component of complement in the cerebrospinal fluid in systcmic lupus erythematosus. Arthr Rheum 1973; 16: 507-21.
    CrossrefPubMedGoogle Scholar
  • 19 Hazelton R A, Reid A C, Rooney P J. Cerebral systcmic lupus erythematosus: a case report and evaluation of diagnostic tests. J Neurol Ncurosurg Psychiatr 1980; 43: 357-9.
    Google Scholar
  • 20 Hiraiwa M, Nonaka C, Toshiaki A, Masaaki I. PET in systcmic lupus erythematosus: relation of cerebral vasculitis to PET-findings. Am J Ncuroradiol 1983; 04: 541-3.
    Google Scholar
  • 21 Hirano T, Hashimoto H, Shiokawa Y. et al. Antiglycolipid autoantibody dctcctcd in the sera from systcmic lupus erythematosus patients. J Clin Invest 1980; 66: 1437-40.
    CrossrefPubMedGoogle Scholar
  • 22 Johnson R T, Richardson E P. The neurological manifestations of systcmic lupus erythematosus. Medicine 1968; 47: 337-69.
    CrossrefPubMedGoogle Scholar
  • 23 Kushner M, Chawluk J, Fazekas F. et al. Cerebral blood flow in systcmic lupus erythematosus with or without neurological complications. Neurology 1987; 37: 1596-8.
    CrossrefPubMedGoogle Scholar
  • 24 Lechner K. Lupus anticoagulants and thrombosis. In: Verstraete M, Vermylen J, Lijnen R, Arnout J. eds. Thrombosis and haemostasis. Leuven: University Press; 1987: 525-47.
    Google Scholar
  • 25 McCune W J, MacGuire A, Aisen A, Gebarski S. Identification of brain lesions in neuropsychiatric systemic lupus erythematosus by magnetic resonance scanning. Arthr Rheum 1988; 31: 159-66.
    CrossrefPubMedGoogle Scholar
  • 26 McDonald K, Hutchinson M, Bresnihan B. The frequent occurrence of neurological disease in patients with late-onset systemic lupus erythematosus. Br J Rheumatol 1984; 23: 186-9.
    CrossrefPubMedGoogle Scholar
  • 27 Miller D H, Ormerod I E C, Gibson A. et al. MR brain scanning in patients with vasculitis: differentiation from multiple sclerosis. Neuroradiol 1987; 29: 226-31.
    CrossrefPubMedGoogle Scholar
  • 28 Petz L D, Sharp G C, Cooper N R, Irvin W S. Serum and cerebrospinal fluid complement and serum autoantibodies in systemic lupus erythematosus. Medicine (Baltimore) 1971; 50: 259-75.
    CrossrefPubMedGoogle Scholar
  • 29 Pinching A J, Travers R L, Hughes G R V. Oxygen-15 brain scanning for detection of cerebral involvement in systemic lupus erythematosus. Lancet 1978; i: 898-900.
    PubMedGoogle Scholar
  • 30 Sanders E A C M, Hogenhuis L A H. Cerebral vasculitis as presenting symptom of systemic lupus erythematosus. Acta Neurol Scand 1986; 74: 75-7.
    PubMedGoogle Scholar
  • 31 Small P, Mass M F, Kohler P F, Harbeck R J. Central nervous system involvement in SLE: diagnostic profile and clinical features. Arth Rheum 1977; 20: 869-78.
    CrossrefPubMedGoogle Scholar
  • 32 Tan E M, Cohen A S, Fries J E. et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthr Rheum 1982; 25: 1271-7.
    CrossrefPubMedGoogle Scholar
  • 33 Tan R F, Gladman D D, Urowitz M B, Milne N. Brain scan diagnosis of central nervous system involvement in SLE. Ann Rheum Dis 1978; 37: 357-62.
    CrossrefPubMedGoogle Scholar
  • 34 Trevor R P, Sondheimer F K, Fessel W J, Wolpert S M. Angiographic demonstration of major cerebral vessel occlusion in systemic lupus erythematosus. Neuroradiol 1972; 04: 202-7.
    CrossrefPubMedGoogle Scholar
  • 35 Vermess M, Bernstein R M, Byddcr G M. et al. Nuclear magnetic resonance imaging of the brain in systemic lupus erythematosus. J Comput Assist Tomogr 1983; 07: 461-7.
    CrossrefPubMedGoogle Scholar
  • 36 Weinberger J, Gordon J, Hodson A K, Goldberg H I Rcivich M. Effect of intraccrcbral vasculitis on regional cerebral blood flow. Arch Neurol 1979; 36: 681-5.
    CrossrefPubMedGoogle Scholar
  • 37 Williams G W, Bluestein H G, Steinberg A D. Brain-reactive lymphocytotoxic antibody in the cerebrospinal fluid of patients with systemic lupus crythcmtosus: correlation with central nervous system involvement. Clin Immunol Immunopathol 1981; 18: 126-32.
    CrossrefPubMedGoogle Scholar
  • 38 Wilson H A, Winfiled J B, Lahita R G, Kofflcr D. Association of lgG-anti-brain antibodies with central nervous system dysfunction in systemic lupus erythematosus. Arthr Rheum 1979; 22: 458-62.
    CrossrefPubMedGoogle Scholar
  • 39 Winfield J B, Shaw M. Silverman et al. Intrathecal IgG-synthcsis and blood-brain barrier impairment in patients with SLE and CNS-dysfunction. Am J Med 1983; 74: 837-44.
    CrossrefPubMedGoogle Scholar
  • 40 Zvaifler N J, Bluestein H G. The pathogenesis of CNS-manifestations of systemic lupus erythematosus. Arthr Rheum 1982; 25: 862-6.
    CrossrefPubMedGoogle Scholar