Einsatz der FDG-PET bei der Diagnostik des zentralnervösen Lupus erythematodes und Vergleich mit CT und MRI^[*]

Central nervous system involvement has been found in 30-75% of all cases of systemic lupus erythematosus (SLE). Up to now, clinical diagnosis is difficult and there are no markers for disease activity. We have compared cranial computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) using fluorodesoxyglucose (FDG) in two cases. FDG-PET is shown to be the most sensitive method demonstrating even reversible deficits and a better correlation with other neurological findings. MRI seems to be more sensitive than CT. A survey of the literature concerning imaging methods in neuropsychiatric SLE is given. The special problem of neuronal desactivation by antineuronal activity is discussed.

Zusammenfassung

Die zentralnervöse Beteiligung ist beim systemischen Lupus erythematodes mit 30-75% ein häufiges Problem. Klinisch schwierig ist die spezifische Diagnostik und die Beurteilung der Krankheitsaktivität. An zwei exemplarischen Fällen werden kraniales Computertomogramm (CT), Kernspintomogramm (MRI) und Positronenemissionstomographie (PET) mit Fluordesoxyglukose (FDG) miteinander verglichen. Es wird gezeigt, daß letztere Methode weit sensibler ist, reversible Veränderungen aufzeigt und eine bessere Korrelation zu den übrigen klinischen Sachverhalten hat. Das MRI ist dem CT an Aussagekraft überlegen. Ein Überblick über die entsprechende Literatur wird gegeben. Auf die besondere Problematik des Nachweises neuronaler Desaktivierung durch sogenannte antineuronale Aktivität wird eingegangen.

^* Herrn Prof. Dr. D. Emrich, Göngen, zum 60. Geburtstag.

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