MELBOURNE (FRONTLINE MEDICAL NEWS) – SPECT imaging can identify abnormalities in brain perfusion in patients with multiple antiphospholipid antibodies and neuropsychiatric symptoms, but without a history of thrombosis, according to a study presented at an international congress on systemic lupus erythematosus.

The retrospective study by researchers from National Taiwan University Hospital addresses the challenge posed by patients who have antiphospholipid antibodies and neuropsychiatric symptoms but do not meet the full criteria for antiphospholipid syndrome because of a lack of a history of thromboembolism. Current antiphospholipid syndrome classification criteria are based on thrombosis or pregnancy loss, with a third category of noncriteria manifestations that include a range of neuropsychiatric symptoms, said presenter Ting-Syuan Lin, MD, of the Yun-Lin Branch of National Taiwan University Hospital.

Based on the study’s findings. Dr. Lin said that if patients did not show any abnormalities on CT scanning or MRI, SPECT imaging might be suitable to investigate for problems with perfusion.

“Some physicians may not give the patient early treatment because they do not fill the criteria,” Dr. Lin said in an interview. “But if we have SPECT image to document the abnormality, then the physician can have more confidence to give them early treatment.”

Dr. Lin and his colleagues looked at the brain SPECT images of 54 patients with a history of positive antiphospholipid antibodies and neuropsychiatric symptoms, but who had no history of thromboembolism or other lupus-related antibodies such as antibodies to double-stranded DNA. When the researchers looked simply at mean brain perfusion according to the number of antiphospholipid antibodies each patient had, they found no significant differences between the groups, including a control group of six patients without antiphospholipid antibodies.

But when they examined heterogeneity of brain perfusion, they saw significantly greater heterogeneity (P = .01) in patients with four antiphospholipid antibodies compared with patients who had no antibodies.

The patients enrolled in the study presented with a range of neuropsychiatric symptoms. The most common was headache (56.7%), followed by dizziness (41.7%), depression (28.3%), psychosis (15%), vertigo (8.3%), and seizures (6.7%). The mean age of the patients was 38 years, and 52 of the patients were women.

One of the patients – a 39-year-old woman with more than four antiphospholipid antibodies – had a normal CT scan but showed significant heterogeneity in brain perfusion on the SPECT imaging. She experienced a stroke 1 year after the study.

Commenting on the presentation, session cochair Timothy Godfrey, MBBS , of St. Vincent’s Hospital in Melbourne, said neuropsychiatric lupus was particularly problematic, especially when patients had normal imaging.

“You’re wondering is the patient just depressed or is there some other explanation, or do they truly have a manifestation of lupus which may require immunosuppression or anticoagulation?” he said in an interview.

This study “is highlighting the fact that maybe we do need to do these tests when the MRI is normal, particularly in people that have documented abnormalities in their blood test.”

Dr. Lin said the next phase of the study would look at whether treatment was associated with changes in brain perfusion on SPECT, and whether the abnormality of the SPECT imaging correlated with clinical outcomes.

No conflicts of interest were declared.


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