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目的评价单光子发射计算机断层扫描(singlephotonemissioncomputedtomography,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。
Objective To evaluate the value of single photon emission computed tomography (SPECT) in the diagnosis of central nervous system diseases (CNS-SLE) in systemic lupus erythematosus. METHODS: Twenty-one patients with SLE underwent SPECT and were independently read by more than two nuclear medicine physicians who were trained and unaware of the patient’s condition to identify abnormalities of cerebral blood flow perfusion. Ten patients with CNS-SLE underwent both cranial CT and / or magnetic resonance imaging (MRI). Results Of the 10 CNS-SLE cases, 9 cases had positive skull SPECT (positive rate 90%), while only 4 cases had positive skull CT / MRI (positive rate 40%). 9 cases were moderate to severe perfusion decreased, 9 cases had frontal and / or parietal involvement (6 cases of frontal involvement, 4 cases of parietal involvement, 5 cases of basal ganglia involvement, 1 case of temporal lobe involvement, 0 Occipital occipital involvement, 7 cases involving multiple regions). Three cases of CNS-SLE patients before and after treatment SPECT performance comparison found that the effective treatment of clinical symptoms improved, SPECT anomaly subsequently significantly improved or even disappear completely. Of the 11 non-CNS-SLE patients, only 2 had a positive SPECT (positive rate 18%), and all had mild hypoperfusion (1 occipital lobe and 1 basal ganglia), none of them had frontal or top Leaves involved. Conclusion SPECT is a sensitive detection method for CNS-SLE, and it has important reference value for monitoring the changes of disease and guiding the treatment. SPECT of SLE patients show multiple lesions, including frontal lobe and / or parietal lobe involvement and moderate to severe blood Decreased flow perfusion suggestive of CNS involvement.