Int J Clin Lab Res (1998) 28:34-38 © Springer-Verlag 1998 A. Postiglione • S. De Chiara • A. Sorieelli. A. Oriente A. Ruocco • G. Spadaro • S. Montefusco • G. Marone A. Genovese Alterations of cerebral blood flow and antiphospholipid antibodies in patients with systemic lupus erythematosus Received: 3 February 1997 / Accepted: 24 November 1997 Abstract Twenty-two patients with systemic lupus ery- thematosus and 13 healthy controls were included in a ce- rebral blood flow study and underwent brain-dedicated sin- gle-photon emission computed tomography using 99mtech- netium-d, 1-hexamethylpropylene amine oxime together with a brain computed tomography scan. Plasma levels of antiphospholipid antibodies (lupus anticoagulant and anticardiolipin IgM and IgG antibodies) were also deter- mined. Brain computed tomography showed signs of fo- cal cerebral ischemia in 4 patients (18%), whereas cere- bral blood flow by single-photon emission computed to- mography was abnormal in 13 of 22 patients (59%), who showed bilateral or monolateral hypoperfusion in the tem- poro-parietal regions. Patients with abnormal cerebral blood flow had a longer duration of disease than those with normal blood flow (8.9_1.9 years vs. 5.3_+1.5 years, P<0.05). Plasma antiphospholipid antibodies were present in 15 patients (68%), but the prevalence was similar in those with normal (6/9,66%), or abnormal (9/13, 69%) ce- rebral blood flow. No statistically significant difference in lupus anticoagulant or anticardiolipin antibodies was ob- served between patients with and without cerebral blood flow abnormalities. Our study shows that patients with systemic lupus erythematosus frequently have cerebral blood flow abnormalities, which could precede those ob- served by computed tomography. Plasma lupus anticoag- ulant and anticardiolipin titers were not correlated with normal cerebral blood flow. A. Postiglione • S. De Chiara • A. Ruocco • S. Montefusco Department of Clinical and Experimental Medicine, University of Naples Federico II, School of Medicine, Naples, Italy A. Soricelli Department of Diagnostic Imaging, University of Naples Federico II, School of Medicine and Medical Research Council Center of Nuclear Medicine, Naples, Italy A. Oriente • G. Spadaro. G. Marone (~) • A. Genovese Division of Clinical Immunology and Allergy. Department of Medicine, University of Naples Federico II, School of Medicine, Via S. Pansini 5, 1-80131 Naples, Italy Key words Cerebral blood flow - Systemic lupus erythematosus • Antiphospholipid antibodies Introduction Neurological and psychiatric symptoms represent one of the most serious complications in patients with systemic lupus erythematosus (SLE) [1, 2]. Clinical manifestations are heterogeneous and range from behavioral and/or mood changes to signs of cerebral excitation (i. e., epilepsy), or focal deficit (such as hemiplegia), headaches (often mi- graine-like), cerebellar or brainstem symptoms, and dys- kinesia of different forms. The frequency of these compli- cations ranges from 24% to 75% [3-6]. This variability could be partly explained by cerebral side effects of corti- costeroids, frequently administered in these patients. Plasma antiphospholipid (aPL) antibodies [lupus anti- coagulant (LAC) and anticardiolipin antibodies (aCL)] have been detected in approximately 50% of SLE patients, but the prevalence could be higher in those with a history of venous or arterial thrombosis [7-9]. The association of aPL with thrombosis, including focal cerebral ischemia, is clear in many studies [10- 14]. Several studies have suggested the usefulness of single- photon emission computed tomography (SPECT) for the assessment of cerebral complications of SLE, showing this technique to be more sensitive than computed tomography (CT) or magnetic resonance imaging (MRI) in identifying early signs of cerebral complications [15-20]. However, few studies have focused on the possible relationship between perfusion defects and the presence of aPL anti- bodies in SLE patients. The aim of our study was to inves- tigate brain morphology of SLE patients b~( CT scan, cere- CT usln c~ 9~m echnetlum d bral blood flow (CBF) by SPE " ~, t " - , 1-hexamethyl propylene amin oxime (99mTc-HMPAO), and to correlate the presence/absence of abnormalities with the presence of aPL antibodies. The results were compared with those of a sex- and age-matched healthy control group.