Neuropsychological Correlates of Brain Perfusion SPECT in Patients with Macrophagic Myofasciitis

<div><p>Background</p><p>Patients with aluminum hydroxide adjuvant-induced macrophagic myofasciitis (MMF) complain of arthromyalgias, chronic fatigue and cognitive deficits. This study aimed to characterize brain perfusion in these patients.</p><p>Methods</p><p>Brain perfusion SPECT was performed in 76 consecutive patients (aged 49±10 y) followed in the Garches-Necker-Mondor-Hendaye reference center for rare neuromuscular diseases. Images were acquired 30 min after intravenous injection of 925 MBq ^99mTc-ethylcysteinate dimer (ECD) at rest. All patients also underwent a comprehensive battery of neuropsychological tests, within 1.3±5.5 mo from SPECT. Statistical parametric maps (SPM12) were obtained for each test using linear regressions between each performance score and brain perfusion, with adjustment for age, sex, socio-cultural level and time delay between brain SPECT and neuropsychological testing.</p><p>Results</p><p>SPM analysis revealed positive correlation between neuropsychological scores (mostly exploring executive functions) and brain perfusion in the posterior associative cortex, including cuneus/precuneus/occipital lingual areas, the periventricular white matter/corpus callosum, and the cerebellum, while negative correlation was found with amygdalo-hippocampal/entorhinal complexes. A positive correlation was also observed between brain perfusion and the posterior associative cortex when the time elapsed since last vaccine injection was investigated.</p><p>Conclusions</p><p>Brain perfusion SPECT showed a pattern of cortical and subcortical changes in accordance with the MMF-associated cognitive disorder previously described. These results provide a neurobiological substrate for brain dysfunction in aluminum hydroxide adjuvant-induced MMF patients.</p></div

SPM map.

<p>Positive correlation between brain perfusion and Stroop color and word Z-scores with adjustment for age, sex, socio-cultural level and time delay between brain SPECT and neuropsychological testing. Linear regression analysis shows impairment of posterior associative areas. Significant clusters are displayed with T-score values on 2-dimensional axial, coronal and sagittal orientations (glass-brain—left panel) and projected onto a brain rendered 3D MIP (right panel). P-value < 0.005 at the voxel level for clusters ≥ 100 contiguous voxels (corrected for cluster volume). L, left; R, right; A, anterior; P, posterior.</p

SPM map.

<p>Positive correlation between brain perfusion and dichotic listening (left ear words) normalized scores with adjustment for age, sex, socio-cultural level and time delay between brain SPECT and neuropsychological testing. Linear regression analysis shows diffuse impairment of periventricular areas/corpus callosum. Significant clusters are displayed with T-score values on 2-dimensional projections (glass-brain—left panel) and slices of MRI (right panel) templates in axial, coronal and sagittal orientations. <i>P</i>-value < 0.005 at the voxel level for clusters ≥ 100 contiguous voxels (corrected for cluster volume). L, left; R, right; A, anterior; P, posterior.</p