RESEARCH - Clinical validation of the watershed sign as a marker for neuropsychiatric SLE

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Arthritis Rheum. 2008 Feb 29;59(3):332-337 [Epub ahead of print]

Clinical validation of the watershed sign as a marker for

neuropsychiatric systemic lupus erythematosus.

Driver CB, Wallace DJ, Lee JC, Forbess CJ, Pourrabbani S, Minoshima S,

Waxman AD, Weisman MH.

Cedars¡¾Sinai Medical Center, Los Angeles, California.

OBJECTIVE: To study the relationship between single-photon-emission

computed tomography (SPECT) brain imaging and neuropsychiatric

signs/symptoms in a cohort of patients with systemic lupus

erythematosus (SLE), analyzed using a stereotactic surface projection

(SSP) technique. METHODS: Thirty-seven SLE patients were referred for

(99m)Tc-ethyl cysteinate dimer SPECT brain imaging because of

neuropsychiatric signs/symptoms. Nineteen normal controls were studied

with the identical protocol. Reconstructed images were computed and Z

scores were calculated using the SSP technique with the 2-sample

t-tests comparing normal controls with SLE patients, and patients with

mild cognitive dysfunction with those with severe cognitive

dysfunction. The clinical characteristics of SLE patients were

collected by retrospective chart review and categorized according to

American College of Rheumatology case definitions for neuropsychiatric

SLE. Cognitive dysfunction was rated by the treating physician on a

scale of 0-3. RESULTS: Thirty of 37 SLE patients had abnormal SPECT

results. SLE patients had reduced perfusion in the watershed areas of

the frontal lobes bilaterally compared with controls. Additionally,

SLE patients with severe cognitive dysfunction had more severe

perfusion deficits than those with mild cognitive dysfunction. In some

patients with severe cognitive dysfunction, the watershed areas had Z

scores >/=4 SDs below controls.

CONCLUSION: A convenience sample of patients with SLE and

neuropsychiatric signs/symptoms demonstrated reduced perfusion in the

watershed areas of the frontal lobes on SPECT scanning analyzed by the

SSP technique. The severity of findings correlated with severity of

cognitive dysfunction. The area of the brain affected is one that is

susceptible to ischemia.

PMID: 18311758

http://www.ncbi.nlm.nih.gov/pubmed/18311758

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