The evaluation of neuropsychiatric lupus erythematosus by functional neuroimaging. Preliminary results

M. Padovan, A. Locaputo, N. Rizzo, M. Govoni, F. Trotta
2011 Reumatismo  
INTRODUZIONE L' approccio diagnostico strumentale e l'interpretazione dell'imaging delle manifestazioni neurologiche nelle connettiviti sistemiche, ed in particolare nel lupus neuropsichiatrico, presenta ancora oggi punti oscuri, secondari ai limiti intrin-seci delle varie metodiche e alla incompleta conoscenza dei meccanismi patogenetici. Vi sono evidenze sempre più consistenti sul ruolo che alterazioni neurometaboliche, neurochimiche e perfusionali giocano nel lupus neuropsichiatrico e di
more » ... to esse possano precedere la comparsa di lesioni anatomiche. Il progresso scientifico e tecnologico ha fornito, negli ultimi anni, tecniche sensibili e raffinate, capaci di esplorare il versante funzionale identificando anomalie anche in distretti all'apparenza anatomicamente indenni alla valutazione morfologica (1). Scopo di questo studio è stato quello di valutare il contributo di alcune tra le più moderne tecniche di imaging funzionale alla definizione diagnostica e Il neuroimaging funzionale nella valutazione del coinvolgimento neurologico in corso di lupus eritematoso sistemico. Risultati preliminari* SUMMARY Objective: The aim of this study was to investigate the performance of functional neuro-imaging for describe neurological involvement in Lupus Erithematosus Systemicus. Methods. 20 SLE patients were included into this study (18 females / 2 males). Median age was 40.5 years (range 16 -66 ys), 9 patients with a clear neurological involvement, 7 with aspecific neurological symptoms and 4 were asymptomatics, according to 1999 ACR Classification. All patients were underwent to conventional resonance imaging ( RM-FLAIR), RM perfusion ( RM-PWI), RM diffusion (RM-DWI) and cerebral SPECT. The RM techniques was performed using a 1 Tesla "Signa-Horizon" Tomograph by General Eletric: The data analysis was performed from two indipendent neuroradiologist and than trough coordinated evalutation after coregistration of acquired volumes. Results: In 11/20 patients (55%) lesions were demonstrated in RM-FLAIR evaluation, more frequent in cases with focal symptoms than in diffuse. RM-PWI was positive in 50% of cases. SPECT analysis was altered in 85 % of patients. In all patients RM-DWI evaluation was negative. 5 of 29 lesional areas (3 patients) showed by SPECT analysis were positive in RM-PWI. None of them was positive in RM-FLAIR study. After coordinated evaluation of RM-FLAIR, SPECT and RM-PWI, 7 findings were considered false positive. 6 Of patients with negative RM-FLAIR were positive in SPECT and 3 in RM-PWI. Only 1 patient was positive in SPECT and RM-PWI. Conclusions: According to the literature, the RM-FLAIR is a very sensitive procedure to describe the lesional charge, especially in patients with focal symptoms. All lesions was considered as stable outcomes due to negativity of RM-DWI analysis. The SPECT is a sensitive technique to individuate cerebral areas of altered perfusion. The coregistration seems to be an helpful method to improve the explanation of uncertain cases. e the sections are prepared for the microscopic analysis of the various histomorphometric parameters. *Lavoro premiato al XXXIX Congresso SIR, Bari 2002 Parole chiave -Lupus eritematoso sistemico, lupus neuropsichiatrico, neuroimaging.
doi:10.4081/reumatismo.2004.24 fatcat:3yxupnnx7zem5didkv2ukv3koi