Abnormal Regional Cerebral Blood Flow in Systemic Lupus Erythematosus Patients With Psychiatric Symptoms
J Clin Psychiatry 2005;66(7):907-913
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Objective: Single-photon emission computed
tomography (SPECT) studies have demonstrated decreased regional
cerebral blood flow (rCBF) in systemic lupus erythematosus (SLE)
patients. However, no study has done voxel-based analysis using
statistical parametric mapping (SPM) that can evaluate rCBF
objectively, and the relationship between rCBF and psychiatric
symptoms has not been well investigated. Using L,L-ethyl
cysteinate dimer (99mTc ECD) SPECT and SPM,
we aimed to clarify the association of rCBF changes with
psychiatric symptoms in SLE patients whose magnetic resonance
imaging (MRI) showed no morphological abnormalities.
Method: Twenty SLE patients and 19 healthy
volunteers underwent 99mTc ECD SPECT. Data were
collected from August 2000 to March 2003. SLE was diagnosed
according to American College of Rheumatology criteria, and
psychiatric symptoms were diagnosed according to ICD-10 criteria.
On the basis of the modified Carbotte, Denburg, and Denburg
method, the patients were classified into 3 groups: a group with
major psychiatric symptoms (hallucinosis, delusional disorder,
and mood disorder), a group with minor psychiatric symptoms
(anxiety disorder, dissociative disorder, and emotionally labile
disorder), and a group without psychiatric symptoms. Gross
organic lesions were ruled out by brain MRI. Group comparisons of
rCBF were performed with analysis using SPM99.
Results: SLE patients without MRI lesions showed
decreased rCBF in the posterior cingulate gyrus and thalamus. The
reduction in rCBF was overt in patients with major psychiatric
Conclusion: Our study indicated that SLE
patients may have dysfunction in the posterior cingulate gyrus
and thalamus and that this may be associated with the severity of