technetium-tc-99m-exametazime and Sjogren-s-Syndrome

Neuropsychiatric disturbances are frequent in connective tissue diseases. Little is known about the cerebral pathophysiology of Sjögren's syndrome, including cerebral blood flow disturbances. 99Tcm-HMPAO brain SPET was performed in 21 Sjögren's syndrome patients. We also studied 77 patients with systemic lupus erythematosus and 27 healthy individuals. Our results demonstrate the high rate of alterations in cerebral blood flow in Sjögren's syndrome, both psychoneurologically symptomatic and asymptomatic. Focal interhemispherical perfusion deficits were seen in 17 of 21 patients (80.9%) with Sjögren's syndrome: 13/15 symptomatic (86.6%) and 4/6 asymptomatic (66.6%). These changes were mostly localized in the prefrontal and frontal areas, occipital lobes and occipitoparietal area, and less frequently so in the temporal, parietal and central areas. Diffuse hypoperfusion of the frontal lobes (bilateral hypofrontality) was seen in 29% of patients in the Sjögren's group. An acetazolamide stress test was performed in seven patients. There was an increase in perfusion deficits in two patients, no change in two patients, and hypoperfusion decreased in three patients compared with baseline. The results indicate that most Sjögren's syndrome patients experience alterations in cerebral blood flow that are consistent with systemic lupus erythematosus, with heterogeneous reactivity to acetazolamide-induced hypercapnia. These alterations present as focal perfusion deficits and bilateral diffuse hypoperfusion of the lobes. The mechanism of cerebral blood flow alterations is unknown, although it might be the result of diffuse cerebral vasculitis.

Topics: Acetazolamide; Adult; Aged; Brain; Carbonic Anhydrase Inhibitors; Cerebrovascular Circulation; Female; Humans; Image Processing, Computer-Assisted; Lupus Erythematosus, Systemic; Male; Middle Aged; Radiopharmaceuticals; Sjogren's Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To investigate the clinical, neuropsychological and imaging manifestations of Sjögren's syndrome (SS), a chronic auto-immune disease with peripheral and central nervous system (CNS) involvement.. Fourteen female patients suffering from confirmed SS underwent within 2 weeks: neurological examination, immunological staging, brain MRI, brain 99m Tc-HMPAO SPECT, psychological evaluation and in-depth neuropsychological testing.. All patients showed neuropsychological abnormalities. The cognitive symptoms were of the same type in all patients, mostly frontal lobe syndrome and memory problems. The neuropsychological involvement was not associated with other kinds of CNS involvement or MRI abnormalities, but accurately reflected HMPAO imaging results.. The results of this study indicate that cognitive evaluation is the most sensitive clinical test to diagnose CNS involvement in patients with SS, and that CNS involvement in SS seems to be more frequent when systematically assessed by neuropsychological tests.

Topics: Adult; Brain; Brain Diseases; Cognition; Female; Humans; Interview, Psychological; Magnetic Resonance Imaging; Memory; Middle Aged; Neuropsychological Tests; Prospective Studies; Psychological Tests; Sjogren's Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Technetium-99m-hexamethylpropylene amine oxime (HMPAO) brain images with fanbeam SPECT, in combination with surface three-dimensional display, were used to detect basal ganglion and cerebral cortex anomalies in Sjögren's syndrome patients.. Forty-eight female Sjögren's syndrome patients with normal brain CT or magnetic resonance imaging findings were enrolled in this study and were investigated using 99mTc-HMPAO brain images with fanbeam SPECT and surface three-dimensional display. These patients were separated into two subgroups. Group 1 consisted of 38 patients with definite neuropsychiatric symptoms/signs and Group 2 consisted of 10 patients without any neuropsychiatric symptoms/signs.. Fanbeam SPECT demonstrated unilateral or bilateral hypoactivity of basal ganglia and thalamus in 14% and 0% of patients in Groups 1 and 2, respectively. Using surface three-dimensional display of the brain, local hypoactivity anomalies were found in the brain cortex of 53% and 20% of patients in Groups 1 and 2, respectively. In Group 1 patients, parietal lobes were the most common areas of brain involvement. The cerebellum and thalamus were the least common areas of brain involvement. In Group 2 patients, parietal and temporal lobes were the most common areas of brain involvement.. This study suggests that 99mTc-HMPAO brain imaging with fanbeam SPECT, in combination with surface three-dimensional display, is a sensitive tool for detecting regional cerebral anomalies in Sjögren's syndrome patients with and without neuropsychiatric symptoms/signs.

Topics: Adult; Brain; Case-Control Studies; Female; Humans; Image Processing, Computer-Assisted; Middle Aged; Radiopharmaceuticals; Sensitivity and Specificity; Sjogren's Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Involvement of the brain is one of the most important complications of Sjögren's syndrome (SS). However, diagnosis of brain involvement in SS patients is difficult due to the lack of effective imaging methods. In this study, we compared two updated brain imaging modalities, 18F-2-fluoro-2-deoxy-D-glucose (FDG) PET and 99mTc-hexamethyl propyleneamine oxime (HMPAO) SPECT, in SS patients with neuropsychiatric manifestations, to detect glucose metabolism of the brain and regional cerebral blood flow.. Sixteen primary female SS patients with normal brain MRI findings were enrolled in this study.. Technetium-99m-HMPAO SPECT findings were abnormal in 13 (81%) patients. Parietal and temporal lobes were the most common areas of brain involvement. Fluorine-18-FDG PET findings were abnormal in 3 (19%) patients. Temporal lobes were the most common areas of brain involvement.. We conclude that brain HMPAO SPECT has better correlation with clinical manifestations than brain FDG PET or CT/MRI.

Topics: Adult; Brain; Brain Diseases; Cerebrovascular Circulation; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Glucose; Humans; Magnetic Resonance Imaging; Middle Aged; Radiopharmaceuticals; Sensitivity and Specificity; Sjogren's Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon