99mTc-HMPAO brain SPECT in the monitoring of cerebral vasculitis therapy

tObjective: The central nervous system (CNS) may be involved in a variety of inflammatory diseases of theblood vessels, generally known as vasculitis. The clinical diagnosis of such involvement in early stagesis difficult, since a mild cognitive impairment can be the only symptom. It was hypothesized that brain-perfusion SPECT would be able to reveal CNS involvement and to monitor the course of the disease. Thepurpose of this study was assess if and when an improvement of cerebral perfusion can be registered bySPECT during the follow-up of these diseases.Material and methods: Eighteen patients affected by Systemic Lupus Erythematosus (SLE), 22 by undif-ferentiated vasculitis (UV), 5 by Behcet’s disease (BD) and 5 by primary Sjogren’s Syndrome (pSS) wereenrolled in this prospective study. A99mTc-HMPAO brain perfusion SPECT was performed before the treat-ment and was repeated during the follow-up at different time intervals. Image analysis was performedon 10 cerebral areas using a specific software.Results: In the SLE patients, no significant improvement of brain perfusion was found. On the contrary,in the UV the cerebral uptake of the tracer significantly improved from the twenty-fourth month (18/22patients). Patients with BD showed an improvement of scintigraphic findings (5/5 patients), while asimilar result was obtained only in 2 of the patients with pSS.Conclusions: In conclusion, brain SPECT seems to be able to monitor the disease in UV, indicating themoment when an improvement of the cerebral perfusion is achieved. In SLE patients this scintigraphictechnique did not show a significant improvement in CNS perfusion.