Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2002 Sep;61(9):774–778. doi: 10.1136/ard.61.9.774

Abnormal regional cerebral blood flow on 99mTc ECD brain SPECT in patients with primary Sjögren's syndrome and normal findings on brain magnetic resonance imaging

C Chang 1, Y Shiau 1, J Wang 1, S Ho 1, A Kao 1
PMCID: PMC1754217  PMID: 12176800

Abstract

Objective: Technetium-99m ethyl cysteinate dimer (99mTc ECD) single photon emission computed tomography (SPECT) of the brain was used to detect abnormal regional cerebral blood flow (rCBF) in patients with primary Sjögren's syndrome (pSS) and normal findings on brain magnetic resonance imaging (MRI).

Methods: 99mTc ECD brain SPECT was performed to detect brain lesions showing hypoperfusion in 32 female patients with pSS and definite neuropsychiatric symptoms or signs. Seventeen female patients with pSS without neuropsychiatric symptoms and signs were included as a control group for comparison. All of the 49 patients with pSS had normal findings on brain MRI.

Results: 99mTc ECD brain SPECT showed brain regions with hypoperfusion in 18 (56.3%) of the 32 patients, and parietal lobes were the most common areas with such lesions. By contrast, 99mTc ECD brain SPECT showed brain regions with hypoperfusion in only three (17.6%) of the 17 patients with pSS without neuropsychiatric symptoms or signs.

Conclusion: This study suggests that 99mTc ECD SPECT is a sensitive tool for detecting regions of hypoperfusion in the brains of patients with pSS and neuropsychiatric symptoms or signs and normal findings on brain MRI. However, a review of the literature showed that the 99mTc ECD SPECT findings in patients with pSS were non-specific.

Full Text

The Full Text of this article is available as a PDF (120.7 KB).

Figure 1 .

Figure 1

Open in a new tab

A 40 year old healthy female control. Normal 99mTc ECD SPECT findings consisted of homogeneous rCBF in the grey matter of the cerebral cortex, basal ganglia, and cerebellum without focal hypoperfusion or visible asymmetry.

Figure 2 .

Figure 2

Open in a new tab

A 43 year old woman with primary Sjögren's syndrome and definite neuropsychiatric symptoms or signs (patient No 25 in table 1). 99mTc ECD SPECT showed regions of hypoperfusion in the left parietal-temporal lobes and basal ganglion (arrows).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander E. L., Provost T. T., Stevens M. B., Alexander G. E. Neurologic complications of primary Sjögren's syndrome. Medicine (Baltimore) 1982 Jul;61(4):247–257. doi: 10.1097/00005792-198207000-00004. [DOI] [PubMed] [Google Scholar]
  2. Asenbaum S., Brücke T., Pirker W., Pietrzyk U., Podreka I. Imaging of cerebral blood flow with technetium-99m-HMPAO and technetium-99m-ECD: a comparison. J Nucl Med. 1998 Apr;39(4):613–618. [PubMed] [Google Scholar]
  3. Berman J. L., Kashii S., Trachtman M. S., Burde R. M. Optic neuropathy and central nervous system disease secondary to Sjögren's syndrome in a child. Ophthalmology. 1990 Dec;97(12):1606–1609. doi: 10.1016/s0161-6420(90)32369-2. [DOI] [PubMed] [Google Scholar]
  4. Devinsky O., Petito C. K., Alonso D. R. Clinical and neuropathological findings in systemic lupus erythematosus: the role of vasculitis, heart emboli, and thrombotic thrombocytopenic purpura. Ann Neurol. 1988 Apr;23(4):380–384. doi: 10.1002/ana.410230411. [DOI] [PubMed] [Google Scholar]
  5. Donnemiller E., Heilmann J., Wenning G. K., Berger W., Decristoforo C., Moncayo R., Poewe W., Ransmayr G. Brain perfusion scintigraphy with 99mTc-HMPAO or 99mTc-ECD and 123I-beta-CIT single-photon emission tomography in dementia of the Alzheimer-type and diffuse Lewy body disease. Eur J Nucl Med. 1997 Mar;24(3):320–325. doi: 10.1007/BF01728771. [DOI] [PubMed] [Google Scholar]
  6. Fox R. I., Howell F. V., Bone R. C., Michelson P. Primary Sjogren syndrome: clinical and immunopathologic features. Semin Arthritis Rheum. 1984 Nov;14(2):77–105. doi: 10.1016/0049-0172(84)90001-5. [DOI] [PubMed] [Google Scholar]
  7. Gerraty R. P., McKelvie P. A., Byrne E. Aseptic meningoencephalitis in primary Sjögren's syndrome. Response to plasmapheresis and absence of CNS vasculitis at autopsy. Acta Neurol Scand. 1993 Oct;88(4):309–311. [PubMed] [Google Scholar]
  8. Hietaharju A., Yli-Kerttula U., Häkkinen V., Frey H. Nervous system manifestations in Sjögren's syndrome. Acta Neurol Scand. 1990 Feb;81(2):144–152. doi: 10.1111/j.1600-0404.1990.tb00951.x. [DOI] [PubMed] [Google Scholar]
  9. Hyun Y., Lee J. S., Rha J. H., Lee I. K., Ha C. K., Lee D. S. Different uptake of 99mTc-ECD adn 99mTc-HMPAO in the same brains: analysis by statistical parametric mapping. Eur J Nucl Med. 2001 Feb;28(2):191–197. [PubMed] [Google Scholar]
  10. Jacobsson L. T., Axell T. E., Hansen B. U., Henricsson V. J., Larsson A., Lieberkind K., Lilja B., Manthorpe R. Dry eyes or mouth--an epidemiological study in Swedish adults, with special reference to primary Sjögren's syndrome. J Autoimmun. 1989 Aug;2(4):521–527. doi: 10.1016/0896-8411(89)90185-6. [DOI] [PubMed] [Google Scholar]
  11. Juni J. E., Waxman A. D., Devous M. D., Sr, Tikofsky R. S., Ichise M., Van Heertum R. L., Holman B. L., Carretta R. F., Chen C. C. Procedure guideline for brain perfusion SPECT using technetium-99m radiopharmaceuticals. Society of Nuclear Medicine. J Nucl Med. 1998 May;39(5):923–926. [PubMed] [Google Scholar]
  12. Kao C. H., Ho Y. J., Lan J. L., Changlai S. P., Liao K. K., Chieng P. U. Discrepancy between regional cerebral blood flow and glucose metabolism of the brain in systemic lupus erythematosus patients with normal brain magnetic resonance imaging findings. Arthritis Rheum. 1999 Jan;42(1):61–68. doi: 10.1002/1529-0131(199901)42:1<61::AID-ANR8>3.0.CO;2-9. [DOI] [PubMed] [Google Scholar]
  13. Kao C. H., Lan J. L., ChangLai S. P., Chieng P. U. Technetium-99m-HMPAO brain SPECT in Sjögren's syndrome. J Nucl Med. 1998 May;39(5):773–777. [PubMed] [Google Scholar]
  14. Kao C. H., Lan J. L., ChangLai S. P., Liao K. K., Yen R. F., Chieng P. U. The role of FDG-PET, HMPAO-SPET and MRI in the detection of brain involvement in patients with systemic lupus erythematosus. Eur J Nucl Med. 1999 Feb;26(2):129–134. doi: 10.1007/s002590050368. [DOI] [PubMed] [Google Scholar]
  15. Koyama M., Kawashima R., Ito H., Ono S., Sato K., Goto R., Kinomura S., Yoshioka S., Sato T., Fukuda H. SPECT imaging of normal subjects with technetium-99m-HMPAO and technetium-99m-ECD. J Nucl Med. 1997 Apr;38(4):587–592. [PubMed] [Google Scholar]
  16. Loutfi I., Singh A. Comparison of quantitative methods for brain single photon emission computed tomography analysis in head trauma and stroke. Invest Radiol. 1995 Oct;30(10):588–594. doi: 10.1097/00004424-199510000-00004. [DOI] [PubMed] [Google Scholar]
  17. Léveillé J., Demonceau G., De Roo M., Rigo P., Taillefer R., Morgan R. A., Kupranick D., Walovitch R. C. Characterization of technetium-99m-L,L-ECD for brain perfusion imaging, Part 2: Biodistribution and brain imaging in humans. J Nucl Med. 1989 Nov;30(11):1902–1910. [PubMed] [Google Scholar]
  18. Léveillé J., Demonceau G., Walovitch R. C. Intrasubject comparison between technetium-99m-ECD and technetium-99m-HMPAO in healthy human subjects. J Nucl Med. 1992 Apr;33(4):480–484. [PubMed] [Google Scholar]
  19. Manthorpe R., Manthorpe T., Sjöberg S. Magnetic resonance imaging of the brain in patients with primary Sjögren's syndrome. Scand J Rheumatol. 1992;21(3):148–149. doi: 10.3109/03009749209095089. [DOI] [PubMed] [Google Scholar]
  20. Matsuda H., Li Y. M., Higashi S., Sumiya H., Tsuji S., Kinuya K., Hisada K., Yamashita J. Comparative SPECT study of stroke using Tc-99m ECD, I-123 IMP, and Tc-99m HMPAO. Clin Nucl Med. 1993 Sep;18(9):754–758. doi: 10.1097/00003072-199309000-00005. [DOI] [PubMed] [Google Scholar]
  21. Moutsopoulos H. M., Sarmas J. H., Talal N. Is central nervous system involvement a systemic manifestation of primary Sjögren's syndrome? Rheum Dis Clin North Am. 1993 Nov;19(4):909–912. [PubMed] [Google Scholar]
  22. Neirinckx R. D., Canning L. R., Piper I. M., Nowotnik D. P., Pickett R. D., Holmes R. A., Volkert W. A., Forster A. M., Weisner P. S., Marriott J. A. Technetium-99m d,l-HM-PAO: a new radiopharmaceutical for SPECT imaging of regional cerebral blood perfusion. J Nucl Med. 1987 Feb;28(2):191–202. [PubMed] [Google Scholar]
  23. Nishimura H., Tachibana H., Makiura N., Okuda B., Sugita M. Corticosteroid-responsive parkinsonism associated with primary Sjögren's syndrome. Clin Neurol Neurosurg. 1994 Nov;96(4):327–331. doi: 10.1016/0303-8467(94)90124-4. [DOI] [PubMed] [Google Scholar]
  24. Ogasawara K., Ogawa A., Ezura M., Konno H., Doi M., Kuroda K., Yoshimoto T. Dynamic and static 99mTc-ECD SPECT imaging of subacute cerebral infarction: comparison with 133Xe SPECT. J Nucl Med. 2001 Apr;42(4):543–547. [PubMed] [Google Scholar]
  25. Shen Y. Y., Kao C. H., Ho Y. J., Lee J. K. Regional cerebral blood flow in patients with systemic lupus erythematosus. J Neuroimaging. 1999 Jul;9(3):160–164. doi: 10.1111/jon199993160. [DOI] [PubMed] [Google Scholar]
  26. Strickland R. W., Tesar J. T., Berne B. H., Hobbs B. R., Lewis D. M., Welton R. C. The frequency of sicca syndrome in an elderly female population. J Rheumatol. 1987 Aug;14(4):766–771. [PubMed] [Google Scholar]
  27. Vitali C., Bombardieri S., Moutsopoulos H. M., Balestrieri G., Bencivelli W., Bernstein R. M., Bjerrum K. B., Braga S., Coll J., de Vita S. Preliminary criteria for the classification of Sjögren's syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum. 1993 Mar;36(3):340–347. doi: 10.1002/art.1780360309. [DOI] [PubMed] [Google Scholar]
  28. de la Monte S. M., Hutchins G. M., Gupta P. K. Polymorphous meningitis with atypical mononuclear cells in Sjögren's syndrome. Ann Neurol. 1983 Oct;14(4):455–461. doi: 10.1002/ana.410140410. [DOI] [PubMed] [Google Scholar]
  29. van Dyck C. H., Lin C. H., Smith E. O., Wisniewski G., Cellar J., Robinson R., Narayan M., Bennett A., Delaney R. C., Bronen R. A. Comparison of technetium-99m-HMPAO and technetium-99m-ECD cerebral SPECT images in Alzheimer's disease. J Nucl Med. 1996 Nov;37(11):1749–1755. [PubMed] [Google Scholar]
  30. van Dyck C. H., Lin C. H., Smith E. O., Wisniewski G., Cellar J., Robinson R., Narayan M., Bennett A., Delaney R. C., Bronen R. A. Comparison of technetium-99m-HMPAO and technetium-99m-ECD cerebral SPECT images in Alzheimer's disease. J Nucl Med. 1996 Nov;37(11):1749–1755. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES