Evidence of cerebral hypoperfusion with [99m]tc HMPAO SPECT in Egyptian scleroderma patients

ABSTRACT

The aim of this study was to investigate regional cerebral blood flow [rCBF] with 99mTc-hexamethyl-propylenamine oxine [HMPAO] single photon emission computed tomography [SPECT] in a group of 22 patients affected with systemic sclerosis [SSc]. The SPECT findings were correlated with clinical data and MRI whenever possible. The study was conducted on 22 Egyptian SSc patients in comparison to ten healthy age-matched controls. Subjects affected with concomitant diseases that might interfere with the interpretation of the SPECT results were excluded. SPECT findings were correlated with clinical data, magnetic resonance imaging [MRI] of the brain and magnetic resonance angiography if available. Twelve SSc patients [54.5%] showed cerebral hypoperfusion, focal in 8 [66.7%] patients and diffuse hypoperfusion in 4 [33.3%] patients at the SPECT analysis. MRI was available in 15 patients and was shown to be altered in five of them [33.3%]. Magnetic resonance angiography [MRA] was normal in those five patients except one. No significant differences were found between the group of SSc patients showing hypoperfusion and those showing a normal SPECT scan regarding age, the duration of disease and damage of other organs typically involved in the disease. Focal or diffuse cerebral hypoperfusion was found with SPECT in more than half of the neurologically asymptomatic SSc patients. SPECT was more sensitive in reflecting changes of cerebral blood flow than MRI. The hypoperfusion was not linked to ageing and possibly reflects the cerebral location of the microangiopathic process characterizing the disease