Brain perfusion SPELT in juvenile neuro-Behcet's disease

Regional cerebral blood flow was evaluated by Tc-99m-hexa-methylpropyleneam ine oxime SPELT in 7 patients (age range, 7-18 y; mean age, 9.1 y) affected with Behcet's disease and signs or symptoms of central nervous system invo lvement at different times of their clinical history. Methods: Three patien ts suffered from seizures, 3 patients were affected with severe persistent headache that was refractory to common analgesic and nonsteroidal antiinfla mmatory drugs, and 1 patient had recurrent episodes of acute intracranial h ypertension. Electroencephalography was performed on all patients, MRI on 5 patients, and CT on 1 patient. Brain SPELT was performed using a high-reso lution, brain-dedicated camera. After conventional visual analysis by 2 exp ert readers, 2 transaxial sections were drawn parallel to the bicommissural line: the first across the thalami and the second across the temporal lobe at the level of the mesiotemporal structures. Cortical regions of interest were drawn automatically on the cortical ribbon on the 2 sections; whereas other regions of interest were drawn by hand around the basal ganglia, the thalami, and the mesiotemporal structures. Asymmetry analysis was then app lied, and hypoperfusion was considered when the asymmetry value was >10%. R esults: Hypoperfusion was observed in all patients by visual and asymmetry analyses; this finding was localized mainly in the basal ganglia, the thala mi, and the temporal cortex, including its mesial portion. Temporal hypoper fusion was found primarily in patients with seizures, and hypoperfusion of deep gray nuclei was found mainly in the other patients. Electroencephalogr aphy disclosed brain functional impairment in 5 of 6 patients, whereas MRI showed multiple bilateral white matter lesions in 1 patient suffering from persistent headache. Conclusion: As in adults, perfusion SPELT seems to be very sensitive in disclosing brain abnormalities in children and adolescent s with Behcet's disease and signs or symptoms of central nervous system inv olvement, even with negative findings on brain MRI.