无神经精神症状的系统性红斑狼疮PET/CT脑葡萄糖代谢统计参数图分析

SPM analysis of 18F-FDG PET/CT images in SLE without neuropsychiatric symptoms

目的:应用统计参数图(statistical parametric mapping,SPM)分析方法分析无神经精神症状系统性红斑狼疮(systemic lupus erythematosus,SLE)患者脑内葡萄糖代谢改变情况。方法:选取无神经精神症状SLE患者13例(SLE患者组)及年龄、性别匹配的健康体检者18例(健康对照组)进行常规体部及脑部18F-FDG PET/CT扫描。2组图像分别进行视觉分析及SPM分析,视觉分析主要对其脑萎缩程度、脑葡萄糖代谢分布及体部葡萄糖代谢异常进行对比分析,SPM分析主要对2组的18F-FDG 脑PET图像进行基于体素水平的组间t检验,获得有差异区域的Talairach坐标值,并查出各坐标所对应的脑区。结果:与健康对照组相比,视觉分析可见部分SLE患者存在弥漫性的皮层葡萄糖代谢减低,而双侧基底节区代谢程度则相对较高;SPM分析SLE组双侧额顶叶及右侧枕叶等皮层区域葡萄糖代谢较健康对照组减低(P<0.001),双侧基底节区葡萄糖代谢较对照组增加(P<0.001)。体部无肿瘤性葡萄糖高代谢病灶。结论:18FDG-PET/CT扫描能够敏感地反映脑内葡萄糖代谢变化,SLE患者在疾病早期尚无神经精神症状时即可出现较为广泛的皮层葡萄糖代谢减低,提示有中枢神经系统受累,或可作为神经精神狼疮的临床监测手段。

Objective To analyze the brain 18F-FDG PET/CT scan images of patients with systemic lupus erythematosus (SLE) without neuropsychiatric symptoms by statistical parametric mapping (SPM) analysis, and to explore the changes in brain glucose metabolism and its potential clinical value in patients with SLE without neuropsychiatric symptoms. Methods Totally 13 patients diagnosed with SLE without neuropsychiatric symptoms and 18 healthy subjects matched by age and sex underwent body and brain 18F-FDG PET/CT scans. Visual analysis and SPM analysis were performed on the two groups of images. The brain atrophy, brain radioactivity distribution and body PET image were comparatively analyzed. The two groups' data were analyzed based on voxel level by SPM analysis, and two samples t-test were performed. The Talairach coordinate values of the different regions were obtained, and the brain functional regions corresponding to each coordinate were found. Results Compared with the healthy control group, visual analysis revealed extensive reduction in cortical glucose metabolism in some SLE patients, while bilateral basal ganglia metabolism was relatively higher. SPM analysis showed that in SLE group, bilateral parietal lobe, frontal lobe and right occipital lobe were significantly lower in resting state than in control group (P<0.001), and bilateral basal ganglias were significantly higher in resting state than in control group (P<0.001). No malignant high FDG uptake lesions were observed in body scans of SLE patients. Conclusion The 18F-FDG PET/CT scan can sensitively reflect the changes in cerebral glucose metabolism. In SLE patients, extensive reduction in cortical glucose metabolism can be seen in the early stage without neuropsychiatric symptoms, which indicates that the central nervous system is involved in, and involved nervous system may be used for clinical monitoring of neuropsyschiatric lupus.