1844 The Journal of Rheumatology 2010; 37:9; doi:10.3899/jrheum.100121 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2010. All rights reserved. Cerebral Blood Flow in Depressed Patients with Systemic Lupus Erythematosus GIAMPIERO GIOVACCHINI, MARTAMOSCA, GIANPIERO MANCA, MAURO DELLAPORTA, CLAUDIANERI, STEFANO BOMBARDIERI,ANDREACIARMIELLO, H. WILLIAM STRAUSS, GIULIANO MARIANI, andDUCCIOVOLTERRANI ABSTRACT. Objective. Tocharacterizetheneuralcircuitryinvolvedindepressionassociatedwithsystemiclupus erythematosus (SLE), we used single photon emission computed tomography (SPECT) to study regional cerebral blood flow (CBF) in patients with SLE. Methods. SPECTwith 99m Tc-ethylcysteinate dimer was performed in 30 depressed women patients withSLE,in14womenpatientswithSLEandwithouthistoryofneuropsychiatricdisorders,andin 25 healthy women controls. Magnetic resonance imaging was done for all subjects for diagnostic purposes. Analysis of CBF patterns was performed using statistical parametric mapping. Statistical significancewastakenatuncorrectedp<0.001atclusterlevel. Results. There were no significant differences between depressed and nondepressed patients with SLEforanyrheumatologicvariable.Incomparisontohealthycontrols,depressedpatientswithSLE had significantly reduced CBF in bilateral frontal and temporal cortex; global maximum was locat- ed in the left precentral gyrus. There were no significant CBF differences between nondepressed patients with SLE and controls. Compared to nondepressed patients with SLE, depressed patients withSLEhadsignificantlylowerCBFin2clustersthathadtheirlocalmaximaintherightprecen- tralgyrusandintheleftsuperiortemporalgyrus.ThedurationofSLEcorrelatedwithdecreasedper- fusion in the left middle and superior frontal gyrus. Conclusion. Depressed patients with SLE have CBF reductions in discrete temporal and frontal regions that may account for depressive symptoms. (First Release July 1 2010; J Rheumatol 2010; 37:1844–51; doi:10.3899/jrheum.100121) Key Indexing Terms: SYSTEMICLUPUSERYTHEMATOSUS DEPRESSION CEREBRALBLOODFLOW SPECT From the Regional Center of Nuclear Medicine and the Rheumatology Unit, Department of Internal Medicine, University of Pisa Medical School, Pisa; Nuclear Medicine Unit, S. Andrea Hospital, La Spezia, Italy; and Division of Nuclear Medicine, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. G. Giovacchini, MD, PhD, Regional Center of Nuclear Medicine, University of Pisa Medical School, and Nuclear Medicine Unit, S. Andrea Hospital; G. Manca, MD; G. Mariani, MD; D. Volterrani, MD; M. Della Porta, MD, Regional Center of Nuclear Medicine, University of Pisa Medical School; A. Ciarmiello, MD, Nuclear Medicine Unit, S. Andrea Hospital; C. Neri, MD; M. Mosca, MD; S. Bombardieri, MD, Rheumatology Unit, Department of Internal Medicine, University of Pisa Medical School; H.W. Strauss, Division of Nuclear Medicine, Department of Radiology, Memorial Sloan-Kettering Cancer Center. Address correspondence to Dr. G. Giovacchini, Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy. E-mail: giovacchinig@uhbs.ch Accepted for publication April 21, 2010. Involvement of the central nervous system (CNS) occurs in 20%–75% of patients with systemic lupus erythematosus (SLE) and is a major source of morbidity and mortality 1,2 . The features of neuropsychiatric SLE vary from global to focalcerebraldysfunction,andincludepsychiatricdisorders as well as central and peripheral neurological disorders. Depression is a particularly frequent psychiatric manifesta- tioninpatientswithSLE:itmaybetwiceascommonasin thegeneralpopulation,anditisassociatedwithanincreased risk of attempted suicide 1,2,3,4 . Single photon emission computed tomography (SPECT) with cerebral blood flow (CBF) tracers and positron emis- sion tomography (PET) with ( 18 F)fluorodeoxyglucose [( 18 F)FDG] have demonstrated reduced CBF and reduced cerebral glucose metabolic rate (CMRglc) in various cerebral areas of patients with neuropsychiatric SLE 5,6,7,8,9,10,11,12,13,14,15,16 . Nevertheless, these studies includedpatientswithdifferentpsychiatricdisordersaswell asneurologicaldisorders.Thislimitationprohibitedinvesti- gatingtheneuralcircuitriesinvolvedinSLE-relateddepres- sion. Our aim was to investigate CBF changes in depressed patients with SLE using SPECT with 99m Tc-ethylcysteinate dimer (ECD). MATERIALS AND METHODS Werecruitedforourstudy30consecutivewomenpatientswithSLE(mean age±SD42±12yrs)whosediagnosisofcurrentmajordepressiveepisode hadbeenestablishedaccordingtotheDSM-IVcriteria 17 .Thisdiagnosisis equivalent to the diagnostic category “mood disorder, major depressive- likeepisode”oftheAmericanCollegeofRheumatology(ACR) 18 .Patients www.jrheum.org Downloaded on November 1, 2021 from