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McEntire CRS, Glenn T, Unizony S, Cho T, Reda H, Chwalisz BK. Symmetric leukoencephalopathy associated with systemic lupus erythematosus: A systematic review of a distinctive neurorheumatologic syndrome. Mult Scler Relat Disord 2024; 88:105717. [PMID: 38943754 DOI: 10.1016/j.msard.2024.105717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND A symmetric leukoencephalopathy can occur in the context of systemic lupus erythematosus (SLE), often as a first manifestation of underlying rheumatologic disease. Recognition of this distinctive syndrome can prompt investigation for SLE when undiagnosed, or prompt treatment initiation when the diagnosis is already known. Earlier recognition of this syndrome could lead to more effective treatment of the disease. METHODS Clinical, laboratory, and radiographic features of three patients were described from an academic medical center in the United States with treatment dates between 2015 and 2022. A systematic review of literature from 1991 to 2023 yielded data for an additional 23 patients. RESULTS Twenty-six total patients with symmetric leukoencephalopathy were included in this study. The median age of the patients was 37 years (range 10-69), 22 patients (85 %) were female, and 4 (15 %) were male. Fourteen of 26 patients (54 %) had this as the first clinical manifestation of SLE. Contrast enhancement was present on MRI brain in 3/26 (88 %) patients. Twenty patients (77 %) were treated with pulse-dose steroids, and all but one patient received some immunomodulatory therapy. Seven patients (27 %) progressed to death. No meaningful predictive differences were found between patients who survived and those who did not. CONCLUSIONS In this case series and literature review patients developed symmetric leukoencephalopathy in systemic lupus erythematosus most often as the first clinical manifestation of SLE. Clinicians should consider this syndrome in any patient with acute onset of symmetric leukoencephalopathy on brain magnetic resonance imaging.
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Affiliation(s)
- Caleb R S McEntire
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States.
| | - Trevor Glenn
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Sebastian Unizony
- Rheumatology, Allergy and Immunology Division, Massachusetts General Hospital, Boston, MA, United States
| | - Tracey Cho
- Neuro-Immunology Division, University of Iowa Hospitals and Clinics, United States
| | - Haatem Reda
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Bart K Chwalisz
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
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2
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Su L, Qi Z, Guan S, Wei L, Zhao Y. Exploring the risk factors for ischemic cerebrovascular disease in systemic lupus erythematosus: A single-center case-control study. Front Immunol 2022; 13:978910. [PMID: 36238309 PMCID: PMC9552613 DOI: 10.3389/fimmu.2022.978910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesIschemic cerebrovascular disease (ICVD) is one of the most common and severe complications in systemic lupus erythematosus (SLE). We aim to explore the risk factors for ICVD in SLE and to assess their associated clinical characteristics.MethodsIn this study, 44 lupus patients with ICVD (ICVD-SLE) and 80 age- and sex-matched lupus patients without ICVD (non-ICVD-SLE) who were hospitalized in our center between 2014 and 2021 were enrolled. A comprehensive set of clinical and socio-demographic data was recorded. In the ICVD-SLE group, the modified Rankin score (mRS) at 90 days after the occurrence of ICVD, the brain MRI, and arterial ultrasonography findings were collected. Group comparisons were made with continuous variables using an independent t-test or the Mann–Whitney test, and with categorical variables using the chi-square test or Fisher exact test. Multivariate logistic regression analysis was performed to identify the risk factors for ICVD in SLE. Patients with ICVD-SLE were divided into three subgroups according to the gradations of intracranial arterial stenosis (ICAS). The subgroup comparisons were performed by one-way ANOVA test or Kruskal–Wallis test.ResultsOf the 44 patients with ICVD, 45% had a large-vessel ischemic stroke, 50% had a symptomatic lacunar stroke, and 9% had a transient ischemic attack. 2 (4.5%) had both large-vessel ischemic stroke and symptomatic lacunar stroke. Multivariate logistic regression analysis showed that cutaneous vasculitis (OR=7.36, 95% CI=2.11–25.65), anticardiolipin antibody (aCL) (OR=4.38, 95% CI=1.435–13.350), and lupus anticoagulant (LA) (OR=7.543,95% CI=1.789–31.808) were the risk factors, and hydroxychloroquine (HCQ) therapy (OR=0.198, 95% CI=0.078–0.502) was the protective factor, after controlling for confounders. During the analysis of the subgroups, no significant difference was observed between the patients in the group without internal carotid arterial occlusion (ICAS) and those with severe ICAS except for diagnostic delay. However, patients in the moderate ICAS group were older when SLE occurred (P<0.01), had a longer diagnostic delay (P<0.01), a lower percentage of hypocomplementemia (P=0.05) and steroids and HCQ therapy (P=0.01, P=0.05, respectively), a trend toward lower mRS score, but a higher incidence of carotid atherosclerotic plaque (P<0.01), when compared with the other two subgroups.ConclusionCutaneous vasculitis and antiphospholipid antibodies (aPLs) are associated with an increased risk of ICVD, while HCQ therapy may provide protection against ICVD in SLE. The ICVD in younger lupus patients is associated with complement-mediated inflammation and poorer outcome, and require immunosuppressive therapy, whereas the ICVD in elderly patients are characterized by moderate ICAS and carotid atherosclerotic plaques.
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Affiliation(s)
- Li Su
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhigang Qi
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaochen Guan
- Evidence-Based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lian Wei
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Zhao
- Department of Rheumatology and Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yi Zhao,
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Features of hyperintense white matter lesions and clinical relevance in systemic lupus erythematosus. Chin Med J (Engl) 2022; 135:962-970. [PMID: 35730373 PMCID: PMC9276293 DOI: 10.1097/cm9.0000000000002074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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4
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Ota Y, Srinivasan A, Capizzano AA, Bapuraj JR, Kim J, Kurokawa R, Baba A, Moritani T. Central Nervous System Systemic Lupus Erythematosus: Pathophysiologic, Clinical, and Imaging Features. Radiographics 2022; 42:212-232. [PMID: 34990324 DOI: 10.1148/rg.210045] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by multiple immunologic abnormalities and has the potential to involve the central nervous system (CNS). The prevalence of SLE seems to be growing, possibly because of earlier diagnosis and improved survival; however, the associated mortality is still high. The mortality is associated with disease-related risk factors such as lupus disease activity, young age, and organ damage or with antiphospholipid syndrome (APS). Neuropsychiatric SLE (NPSLE), which is caused by SLE-related CNS involvement, comprises a broad range of neurologic and psychiatric manifestations with varying severity, which can make this disease indistinguishable from other conditions that are unrelated to SLE. No unifying pathophysiology has been found in the etiology of NPSLE, suggesting that this condition has multiple contributors such as various immune effectors and the brain-intrinsic neuroimmune interfaces that are breached by the immune effectors. The postulated neuroimmune interfaces include the blood-brain barrier, blood-cerebrospinal fluid barrier, meningeal barrier, and glymphatic system. On the basis of the immunologic, pathologic, and imaging features of NPSLE, the underlying pathophysiology can be classified as vasculitis and vasculopathy, APS, demyelinating syndrome, or autoimmune antibody-mediated encephalitis. Each pathophysiology has different imaging characteristics, although the imaging and pathophysiologic features may overlap. Moreover, there are complications due to the immunocompromised status caused by SLE per se or by SLE treatment. Radiologists and clinicians should become familiar with the underlying mechanisms, radiologic findings, and complications of NPSLE, as this information may aid in the diagnosis and treatment of NPSLE. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Yoshiaki Ota
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Ashok Srinivasan
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Aristides A Capizzano
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Jayapalli R Bapuraj
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - John Kim
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Ryo Kurokawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Akira Baba
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109
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5
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Elolemy G, Al Rashidi A, Youssry D, Elziat H, Baraka E. Headache in patients with systemic lupus erythematosus: characteristics, brain MRI patterns, and impact. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00078-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The prevalence of primary headache in patients with systemic lupus erythematosus (SLE) varies widely and whether it should be attributed to neurological involvement is controversial. We aimed to investigate the prevalence and characteristics of headache in SLE patients, describe its association with disease-related variables and brain imaging, and explore its impact on life.
Results
The overall prevalence of headache was 54.4%, and migraine was the most common type among headache sufferers (48.4%). Headache severity (VAS) and impact (HIT-6) correlated with SLEDAI-2K (P = 0.019 and P < 0.001, respectively) as well as with each other (P = 0.006). Brain imaging abnormalities were found in 25.8%, with white-matter hyperintensities (WMH) being the most frequent pathology. Musculoskeletal manifestations, positive anti-phospholipid (aPL) antibodies, and SLEDAI score ≥ 13.5 were identified as predictors of headache.
Conclusion
Primary headache, especially migraine, is a common feature of patients with SLE, and its presence is associated with negative impact on quality of life. Musculoskeletal features, aPL positivity, and overall disease activity appear to predict primary headache in SLE.
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Ramirez GA, Rocca MA, Preziosa P, Bozzolo EP, Pagani E, Canti V, Moiola L, Rovere-Querini P, Manfredi AA, Filippi M. Quantitative MRI adds to neuropsychiatric lupus diagnostics. Rheumatology (Oxford) 2021; 60:3278-3288. [PMID: 33367829 DOI: 10.1093/rheumatology/keaa779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/02/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Attributing neuropsychiatric manifestations to SLE is often challenging. Brain white matter lesions are frequent in SLE at MRI, but their diagnostic role is unclear. Here, we assessed whether white matter lesions count, volume and distribution measurement can help in the diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS Brain dual-echo and 3D T1-weighted sequences were acquired from 32 patients with SLE and 32 healthy controls with a 3 T-scanner and employed to derive T2-hyperintense lesion volume (T2LV), number (T2LN) and probability maps (LPM) using a semi-automatic local thresholding segmentation technique. NPSLE was classified as per the ACR nomenclature, the Italian Society for Rheumatology algorithm and by clinical impression. Clinical descriptors including the SLE International Collaborating Clinics/ACR damage index (SDI) were also recorded. RESULTS Higher T2LV were observed in SLE vs healthy controls (P < 0.001) and in NPSLE vs other SLE (P =0.006). Patients with NPSLE also had higher T2LN (P =0.003) compared with other SLE. In SLE, T2LPM revealed a high prevalence of lesions in the splenium of the corpus callosum, right superior longitudinal fasciculus and right corona radiata. T2LV and T2LN correlated with SLE duration (rho = 0.606; P <0.001 and rho = 0.483; P =0.005, respectively) and age (rho = 0.478; P =0.006 and rho = 0.362; P = 0.042, respectively). T2LV also correlated with SDI (rho = 0.352; P =0.048). SLE patients with fatigue had lower T2LN (P =0.038) compared with patients without fatigue. Thresholds of T2LV ≥ 0.423 cm3 or of T2LN ≥ 12 were associated with definite NPSLE and improved the classification of patients with possible NPSLE per clinical impression. CONCLUSION Brain white matter lesions (WML) quantitation adds to NPSLE diagnostics.
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Affiliation(s)
- Giuseppe A Ramirez
- Università Vita-Salute San Raffaele.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases.,Division of Immunogy, Transplantation & Infectious Diseases
| | | | | | | | | | | | | | - Patrizia Rovere-Querini
- Università Vita-Salute San Raffaele.,Division of Immunogy, Transplantation & Infectious Diseases
| | - Angelo A Manfredi
- Università Vita-Salute San Raffaele.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases.,Division of Immunogy, Transplantation & Infectious Diseases
| | - Massimo Filippi
- Università Vita-Salute San Raffaele.,Neuroimaging Research Unit.,Neurology Unit.,Neurophysiology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
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7
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Monahan RC, Inglese F, Middelkoop H, van Buchem M, Huizinga TW, Kloppenburg M, Ronen I, Steup-Beekman GM, de Bresser J. White matter hyperintensities associate with cognitive slowing in patients with systemic lupus erythematosus and neuropsychiatric symptoms. RMD Open 2021; 7:rmdopen-2021-001650. [PMID: 34321253 PMCID: PMC8320250 DOI: 10.1136/rmdopen-2021-001650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/17/2021] [Indexed: 12/31/2022] Open
Abstract
Objective To compare cognitive function between patients with different phenotypes of neuropsychiatric systemic lupus erythematosus (NPSLE) and assess its association with brain and white matter hyperintensity (WMH) volumes. Methods Patients attending the Leiden University Medical Centre NPSLE clinic between 2007 and 2015 without large brain infarcts were included (n=151; 42±13 years, 91% women). In a multidisciplinary consensus meeting, neuropsychiatric symptoms were attributed to systemic lupus erythematosus (SLE) (NPSLE, inflammatory (n=24) or ischaemic (n=12)) or to minor/non-NPSLE (n=115). Multiple regression analyses were performed to compare cognitive function between NPSLE phenotypes and to assess associations between brain and WMH volumes and cognitive function cross-sectionally. Results Global cognitive function was impaired in 5%, learning and memory (LM) in 46%, executive function and complex attention (EFCA) in 39% and psychomotor speed (PS) in 46% of all patients. Patients with inflammatory NPSLE showed the most cognitive impairment in all domains (p≤0.05). Higher WMH volume associated with lower PS in the total group (B: −0.14 (95% CI −0.32 to −0.02)); especially in inflammatory NPSLE (B: −0.36 (95% CI −0.60 to −0.12). In the total group, lower total brain volume and grey matter volume associated with lower cognitive functioning in all domains (all: 0.00/0.01 (0.00;0.01)) and lower white matter volume associated with lower LM, EFCA and PS (all: 0.00/0.01 (0.00;0.01)). Conclusion We demonstrated that an association between brain and WMH volumes and cognitive function is present in patients with SLE, but differs between (NP)SLE phenotypes. WMHs associated with PS especially in inflammatory NPSLE, which suggests a different, potentially more severe underlying pathophysiological mechanism of cognitive impairment in this phenotype.
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Affiliation(s)
| | - Francesca Inglese
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Huub Middelkoop
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.,Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tom Wj Huizinga
- Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Margreet Kloppenburg
- Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Itamar Ronen
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Gerda M Steup-Beekman
- Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Rheumatology, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
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8
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Neuroimaging findings in rheumatologic disorders. J Neurol Sci 2021; 427:117531. [PMID: 34130065 DOI: 10.1016/j.jns.2021.117531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 01/06/2023]
Abstract
Patients with rheumatological diseases may present with neurological manifestations of peripheral and/or central nervous system (CNS). Symptoms may be related to underlying rheumatological disease or CNS effects of immune-modulating drugs. Early diagnosis and therapy may help prevent serious complications. Magnetic resonance imaging (MRI), given its excellent soft tissue details, is the preferred imaging modality when evaluating patients with rheumatological disease and suspected CNS involvement. We present a review of the neuroimaging manifestations of various rheumatic diseases with emphasis on the imaging findings on MRI.
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9
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Silvagni E, Bortoluzzi A, Borrelli M, Padovan M, Furini F, Govoni M. Conventional brain magnetic resonance imaging in the longitudinal evaluation of newly diagnosed systemic lupus erythematosus patients: a retrospective analysis from a single-centre cohort. Lupus 2020; 29:499-504. [PMID: 32138582 DOI: 10.1177/0961203320909955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Neuropsychiatric (NP) manifestations occur mostly in the early phases of the systemic lupus erythematosus (SLE) course. Nonspecific alterations are evident in conventional brain magnetic resonance imaging (MRI), regardless of clinically overt NP symptoms. The main aims of this study were to assess the prevalence of MRI abnormalities in newly diagnosed SLE, and to evaluate the impact of MRI changes during follow-up (FU) and the clinical course of NP symptoms. MATERIALS AND METHODS Newly diagnosed SLE patients with a baseline brain MRI and with available repeated MRI during FU were retrospectively evaluated. White-matter lesions and atrophy were recorded, comparing NPSLE and non-NPSLE patients. Cox proportional hazard models were used to compare NP events during FU with MRI data. RESULTS Forty-four patients were included, 22 with NP events attributed to SLE. The baseline MRI scan was abnormal in 21 patients (47.73%). New NP events occurred in 17 patients, and worsening was found in repeated MRIs in 12 (27.27%). A worsening of MRI was associated with higher occurrence of new NP events during FU (adjusted hazard ratio 3.946 (1.175-13.253)). CONCLUSION Baseline MRI is useful in patients with an early diagnosis of SLE, allowing comparison with subsequent scans. In our study, radiological worsening of repeated brain MRI was associated with new NP events.
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Affiliation(s)
- E Silvagni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - A Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - M Borrelli
- Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - M Padovan
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - F Furini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - M Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
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10
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Mavrogeni S, Koutsogeorgopoulou L, Dimitroulas T, Markousis-Mavrogenis G, Boki K, Katsifis G, Vartela V, Kallenberg CG, Kolovou G, Kitas G. Combined Brain/Heart Magnetic Resonance Imaging in Systemic Lupus Erythematosus. Curr Cardiol Rev 2020; 16:178-186. [PMID: 31368877 PMCID: PMC7536815 DOI: 10.2174/1573403x15666190801122105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/08/2019] [Accepted: 07/19/2019] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular Disease (CVD) in Systemic Lupus Erythematosus (SLE) and Neuropsychiatric SLE (NPSLE) has an estimated prevalence of 50% and 40%, respectively and both constitute major causes of death among SLE patients. In this review, a combined brain/heart Magnetic Resonance Imaging (MRI) for SLE risk stratification has been proposed. The pathophysiologic background of NPSLE includes microangiopathy, macroscopic infarcts and accelerated atherosclerosis. Classic brain MRI findings demonstrate lesions suggestive of NPSLE in 50% of the NPSLE cases, while advanced MRI indices can detect pre-clinical lesions in the majority of them, but their clinical impact still remains unknown. Cardiac involvement in SLE includes myo-pericarditis, valvular disease/endocarditis, Heart Failure (HF), coronary macro-microvascular disease, vasculitis and pulmonary hypertension. Classic and advanced Cardiovascular Magnetic Resonance (CMR) indices allow function and tissue characterization for early diagnosis and treatment follow-up of CVD in SLE. Although currently, there are no clinical data supporting the combined use of brain/heart MRI in asymptomatic SLE, it may have a place in cases with clinical suspicion of brain/heart involvement, especially in patients at high risk for CVD/stroke such as SLE with antiphospholipid syndrome (SLE/APS), in whom concurrent cardiac and brain lesions have been identified. Furthermore, it may be of value in SLE with multi-organ involvement, NPSLE with concurrent cardiac involvement, and recent onset of arrhythmia and/or heart failure.
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Affiliation(s)
- Sophie Mavrogeni
- Address correspondence to this author at the Onassis Cardiac Surgery Center, FESC, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece; Tel/Fax: +30-210-98.82.797; E-mail:
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11
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Mvambo N, Bhigjee AI, Mody GM. Clinical, neuroimaging and immunological phenotype of South African neuropsychiatric systemic lupus erythematosus patients. Lupus 2019; 28:685-694. [PMID: 31018814 DOI: 10.1177/0961203319843351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Neuropsychiatric systemic lupus erythematosus (NPSLE) is an important cause of morbidity and mortality. We undertook this observational retrospective study of patients with NPSLE who had brain magnetic resonance imaging (MRI) to determine the indications for MRI and the correlation of clinical and laboratory findings with MRI. We identified 83 NPSLE patients (84.3% women) seen at Inkosi Albert Luthuli Central Hospital in Durban, South Africa, between June 2003 and May 2017. The mean age at SLE diagnosis was 26.24 ± 12.81 years and the median interval to NPSLE was 11.0 (interquartile range, 4.0-39.0) months. The most common indications for MRI were seizures (45.8%), psychosis (18.1%) and cerebrovascular disease (18.1%). The MRI was abnormal in 68 (81.9%) with small-vessel disease in 65 (78.3%) and large-vessel disease in eight (9.6%). The small-vessel abnormalities were white-matter hyperintensities (WMH) (59.0%), atrophy (55.4%) and lacunae (4.6%). Our patients had high disease activity at NPSLE. Cerebrovascular disease was associated with an abnormal MRI ( p = 0.018) and large-vessel disease ( p = 0.014) on MRI. Our NPSLE patients were younger and had high disease activity, and seizures were more common compared with other studies. The most common MRI abnormalities were WMH and cortical atrophy, in agreement with other studies.
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Affiliation(s)
- N Mvambo
- 1 Department of Rheumatology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - A I Bhigjee
- 2 Department of Neurology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - G M Mody
- 1 Department of Rheumatology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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12
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Nikolopoulos D, Fanouriakis A, Boumpas DT. Cerebrovascular Events in Systemic Lupus Erythematosus: Diagnosis and Management. Mediterr J Rheumatol 2019; 30:7-15. [PMID: 32185337 PMCID: PMC7045913 DOI: 10.31138/mjr.30.1.7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
Stroke is a major cause of morbidity, mortality and disability in systemic lupus erythematosus (SLE). Patients with SLE have a two-fold increase in the risk of stroke with younger patients (ie, less than 50 years of age) having an ever-higher risk (up to 10-fold). Although the prognosis of SLE has improved, mortality due to cerebrovascular events (CVE) remains unchanged. Cerebrovascular disease may be directly attributed to the disease per se, as a manifestation of neuropsychiatric SLE, or be the result of traditional cardiovascular risk factors accompanying the disease. Elucidation of the underlying mechanism(s) of CVE is essential as it may guide the type of therapy (ie, antithrombotic or anticoagulant therapy versus immunosuppressive). Strokes attributed to lupus usually occur early in the course of the disease and are often accompanied by evidence of activity in other organs; those related to antiphospholipid antibodies can occur at any time, in patients with either active or inactive SLE. In this review, we discuss the epidemiology, work-up, management and primary prevention of CVE in patients with lupus. In view of the effectiveness of thrombolysis, physicians need to educate lupus patients and their families for the early recognition of the signs of stroke and the need to seek prompt attention. To this end acronyms, such as FAST (Facial drooping, Arm weakness, Speech difficulties and Time to call emergency service) can be used as a mnemonic to help detect and enhance responsiveness to the needs of a person having a stroke.
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Affiliation(s)
- Dionysis Nikolopoulos
- Rheumatology and Clinical Immunology Unit, 4th Department of Medicine, "Attikon" University Hospital, Athens, Greece.,Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology Unit, 4th Department of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Dimitrios T Boumpas
- Rheumatology and Clinical Immunology Unit, 4th Department of Medicine, "Attikon" University Hospital, Athens, Greece.,Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.,Medical School, University of Cyprus, Nicosia, Cyprus
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13
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Amanat M, Thijs RD, Salehi M, Sander JW. Seizures as a clinical manifestation in somatic autoimmune disorders. Seizure 2019; 64:59-64. [DOI: 10.1016/j.seizure.2018.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/10/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
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14
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Magro-Checa C, Kumar S, Ramiro S, Beaart-van de Voorde L, Eikenboom J, Ronen I, de Bresser J, van Buchem M, Huizinga T, Steup-Beekman G. Are serum autoantibodies associated with brain changes in systemic lupus erythematosus? MRI data from the Leiden NP-SLE cohort. Lupus 2019; 28:94-103. [PMID: 30526327 PMCID: PMC6304692 DOI: 10.1177/0961203318816819] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/09/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The effect of serum autoantibodies on the brain of systemic lupus erythematosus (SLE) patients remains unclear. We investigated whether serum autoantibodies, individually and assessed in groups, are associated with specific brain-MRI abnormalities or whether these structural changes are associated with other SLE-related or traditional cardiovascular disease risk factors. METHODS All patients underwent brain 3Tesla-MRI. White matter hyperintensities (WMHs), ischemic lesions, inflammatory-like lesions and cerebral atrophy were scored. Serum autoantibodies analyzed included lupus anticoagulant (LAC), anticardiolipine (aCL) IgG and IgM (first 3 also grouped into antiphospholipid autoantibodies (aPL)), anti-dsDNA, anti-SSA, anti-SSB, anti-RNP, and anti-Sm (the latter 5 grouped into SLE-related autoantibodies). Associations were assessed using logistic regression analysis adjusted for potential confounders. Furthermore, a sensitivity analysis including anti-Beta2 glycoprotein-1 antibodies (anti-β2GP1) in the aPL group was performed and the potential modification role of the neuropsychiatric clinical status in the model was assessed. RESULTS 325 patients (mean age 42 years (SD 14), 89% female) were included. The following MRI-brain abnormalities were found: WMHs (71%), lacunar infarcts (21%), gliosis (11%), micro-hemorrhages (5%), large hemorrhages (2%), inflammatory-like lesions (6%) and atrophy (14%). No associations were found between individual or total SLE-related autoantibodies and inflammatory-like lesions. A higher number of positive aPL was associated with lacunar infarcts (OR 1.37 (95%CI 1.02-1.99) and gliosis (OR 2.15 (1.37-3.37)). LAC was associated with lacunar infarcts in white matter (OR 3.38 (1.32-8.68)) and atrophy (OR 2.49 (1.01-6.15)), and aCL IgG with gliosis (OR 2.71 (1.05-7.02)). Among other variables, SLE patients with hypertension presented a higher chance for WMHs (OR 5.61 (2.52-12.48)) and lacunar infarcts in WM (OR 2.52 (1.10-5.74)) and basal ganglia (OR 8.34 (2.19-31.70)), while cumulative SLE-damage was correlated with lacunar infarcts in WM (OR 1.43 (1.07-1.90)), basal ganglia (OR 1.72 (1.18-2.51)) and cerebellum (OR 1.79 (1.33-2.41)). These associations were confirmed in the sensitivity analysis. CONCLUSIONS Brain abnormalities in SLE represent different underlying pathogenic mechanisms. aPL are associated with ischemic brain changes in SLE, while the presence of SLE-related serum autoantibodies is not related to inflammatory-like lesions. Hypertension and cumulative SLE-damage associate with ischemic MRI-brain changes in SLE, suggesting the importance of accelerated atherosclerosis in this process.
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Affiliation(s)
- C. Magro-Checa
- Department of Rheumatology, Leiden
University Medical Center, Leiden, the Netherlands
- Department of Rheumatology, Zuyderland
Medical Center, Heerlen, the Netherlands
| | - S. Kumar
- Department of Neuroradiology,
National
Neuroscience Institute, Singapore
| | - S. Ramiro
- Department of Rheumatology, Leiden
University Medical Center, Leiden, the Netherlands
- Department of Rheumatology, Zuyderland
Medical Center, Heerlen, the Netherlands
| | | | - J. Eikenboom
- Department of Thrombosis and Hemostasis,
Leiden University Medical Center, Leiden, the Netherlands
| | - I. Ronen
- CJ Gorter Center for High Field MRI,
Department of Radiology, Leiden University Medical Center, Leiden, the
Netherlands
| | - J de Bresser
- Department of Radiology, Leiden
University Medical Center, Leiden, The Netherlands
| | - M.A van Buchem
- Department of Radiology, Leiden
University Medical Center, Leiden, The Netherlands
| | - T.W. Huizinga
- Department of Rheumatology, Leiden
University Medical Center, Leiden, the Netherlands
| | - G.M. Steup-Beekman
- Department of Rheumatology, Leiden
University Medical Center, Leiden, the Netherlands
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15
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Yeoh H, Lee JY, Lee YJ, Park DW, Kim TY, Ahn GY, Bae SC, Kim YS, Kim HY, Kim CK, Kim JY, Kim H, Han JW. Relationship between cerebral microbleeds and white matter MR hyperintensities in systemic lupus erythematosus: a retrospective observational study. Neuroradiology 2018; 61:265-274. [PMID: 30415319 DOI: 10.1007/s00234-018-2130-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE White matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are known to be associated with small vessel diseases (SVD) and neuroinflammation. The purpose was to investigate the relationship between CMBs and WMH in patients with systemic lupus erythematosus (SLE). METHODS Thirty-one SLE patients with WMH and 27 SLE patients with normal brain MRI were compared. The presence, location, and grading of CMBs were assessed using susceptibility-weighted images. WMH volume was quantitatively measured. Clinical characteristics and serologic markers were compared. We also performed two separate subgroup analyses after (1) dividing WMH into inflammatory lesion vs. SVD subgroups and (2) dividing WMH into those with vs. without CMB subgroups. RESULTS The WMH group showed more frequent CMBs than the normal MR group (p < 0.001). The WMH group showed higher SLE disease activity index, longer disease duration, and a higher incidence of antiphospholipid syndrome than the normal MR group (p = 0.02, 0.04, and 0.04, respectively). There was a moderate correlation between WMH volume and CMB grading (r = 0.49, p = 0.006). Within the WMH group, the inflammatory lesion subgroup showed more frequent CMBs and larger WMH volume than the SVD subgroup (p < 0.001 and 0.02, respectively). The WMH with CMB subgroup had larger WMH volume than the WMH without CMB subgroup (p = 0.004). CONCLUSION In patients with SLE, CMBs could be related to large-volume WMH and inflammatory lesions. CMBs along with severe WMH could be used as an imaging biomarker of vasculitis in patients with SLE.
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Affiliation(s)
- Hyunjung Yeoh
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, South Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, South Korea.
| | - Young-Jun Lee
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, South Korea
| | - Dong Woo Park
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Tae Yoon Kim
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Ga Young Ahn
- Department of Rheumatology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Young Seo Kim
- Department of Neurology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun Young Kim
- Department of Neurology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Chun K Kim
- Department of Nuclear Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Haejin Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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16
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Brain white matter structural networks in patients with non-neuropsychiatric systemic lupus erythematosus. Brain Imaging Behav 2018; 12:142-155. [PMID: 28190161 DOI: 10.1007/s11682-017-9681-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Previous neuroimaging studies have revealed cognitive dysfunction in patients with systemic lupus erythematosus (SLE) and suggested that it may be related to disrupted brain white matter (WM) connectivity. However, no study has examined the topological properties of brain WM structural networks in SLE patients, especially in patients with non-neuropsychiatric SLE (non-NPSLE). In this study, we acquired DTI datasets from 28 non-NPSLE patients and 24 healthy controls, constructed their brain WM structural networks by using a deterministic fiber tracking approach, estimated the topological parameters of their structural networks, and compared their group differences. We reached the following results: 1) At the global level, the non-NPSLE patients showed significantly increased characteristic path length, normalized clustering coefficient and small-worldness, but significantly decreased global efficiency and local efficiency compared to the controls; 2) At the nodal level, the non-NPSLE patients had significantly decreased nodal efficiency in regions related to movement control, executive control, and working memory (bilateral precentral gyri, bilateral middle frontal gyri, bilateral inferior parietal lobes, left median cingulate gyrus and paracingulate gyrus, and right middle temporal gyrus). In addition, to pinpointing the injured WM fiber tracts in the non-NPSLE patients, we reconstructed the major brain WM pathways connecting the abnormal regions at the nodal level with the corticospinal tract (CST), superior longitudinal fasciculus-parietal terminations (SLFP), and superior longitudinal fasciculus-temporal terminations (SLFT). By analyzing the diffusion parameters along these WM fiber pathways, we detected abnormal diffusion parameters in the bilateral CST and right SLFT in the non-NPSLE patients. These results seem to indicate that injured brain WM connectivity exists in SLE patients even in the absence of neuropsychiatric symptoms.
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17
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Kozora E, Filley CM, Erkan D, Uluğ AM, Vo A, Ramon G, Burleson A, Zimmerman RD, Lockshin MD. Longitudinal evaluation of diffusion tensor imaging and cognition in systemic lupus erythematosus. Lupus 2018; 27:1810-1818. [DOI: 10.1177/0961203318793215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective This pilot study aimed to examine longitudinal changes in brain structure and function in patients with systemic lupus erythematosus (SLE) using diffusion tensor imaging (DTI) and neuropsychological testing. Methods Fifteen female SLE patients with no history of major neuropsychiatric (NP) manifestations had brain magnetic resonance imaging (MRI) with DTI at baseline and approximately 1.5 years later. At the same time points, a standardized battery of cognitive tests yielding a global cognitive impairment index (CII) was administered. At baseline, the SLE patients had mean age of 34.0 years (SD = 11.4), mean education of 14.9 years (SD = 2.1), and mean disease duration of 121.5 months (SD = 106.5). The MRI images were acquired with a 3T GE MRI scanner. A DTI sequence with 33 diffusion directions and b-value of 800 s/mm2 was used. Image acquisition time was about 10 minutes. Results No significant change in cognitive dysfunction (from the CII) was detected. Clinically evaluated MRI scans remained essentially unchanged, with 62% considered normal at both times, and the remainder showing white matter (WM) hyperintensities that remained stable or resolved. DTI showed decreased fractional anisotropy (FA) and increased mean diffusivity (MD) in bilateral cerebral WM and gray matter (GM) with no major change in NP status, medical symptoms, or medications over time. Lower FA was found in the following regions: left and right cerebral WM, and in GM areas including the parahippocampal gyrus, thalamus, precentral gyrus, postcentral gyrus, angular gyrus, parietal lobe, and cerebellum. Greater MD was found in the following regions: left and right cerebral WM, frontal cortex, left cerebral cortex, and the putamen. Conclusions This is the first longitudinal study of DTI and cognition in SLE, and results disclosed changes in both WM and GM without cognitive decline over an 18-month period. DTI abnormalities in our participants were not associated with emergent NP activity, medical decline, or medication changes, and the microstructural changes developed in the absence of macrostructural abnormalities on standard MRI. Microstructural changes may relate to ongoing inflammation, and the stability of cognitive function may be explained by medical treatment, the variability of NP progression in SLE, or the impact of cognitive reserve.
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Affiliation(s)
- E Kozora
- Department of Medicine, National Jewish Health, Denver, CO, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - C M Filley
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Marcus Institute for Brain Health, University of Colorado, Aurora, CO, USA
| | - D Erkan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
| | - A M Uluğ
- CorTechs Labs, San Diego, CA, USA
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - A Vo
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - G Ramon
- Hospital for Special Surgery, New York, NY, USA
| | - A Burleson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | | | - M D Lockshin
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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18
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Corrêa DG, Zimmermann N, Borges RS, Pereira DB, Doring TM, Tukamoto G, Fonseca RP, Gasparetto EL. White-matter integrity in patients with systemic lupus erythematosus and memory deficits. Neuroradiol J 2018; 31:587-595. [PMID: 30091662 DOI: 10.1177/1971400918793601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Cognitive dysfunction is common in neuropsychiatric systemic lupus erythematosus (SLE). Memory is a commonly affected cognitive domain. Clinically, however, it is difficult to detect memory deficits. The objective of this study is to evaluate whether normal controls and SLE patients with and without memory deficit differ in terms of white-matter integrity. METHODS Twenty SLE patients with memory deficit were compared to 47 SLE patients without memory deficit and 22 sex-, age-, and education-matched control individuals. Diffusion tensor imaging (DTI) was performed in a 1.5-Tesla scanner. For tract-based spatial statistics analysis, a white-matter skeleton was created. A permutation-based inference with 5000 permutations with a threshold of p < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) were also projected onto the mean FA skeleton. RESULTS Compared to controls, SLE patients with and without memory deficit had decreased FA in: bilateral anterior thalamic radiation, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, uncinate fasciculus, corticospinal tract, genu, and body of the corpus callosum. SLE patients with and without memory deficit also presented increased MD and RD values compared to controls in these areas. Comparison between SLE patients with and without memory deficit did not present significant differences in DTI parameters. CONCLUSION DTI can detect extensive abnormalities in the normal-appearing white matter of SLE patients with and without memory deficit, compared to controls. However, there was no difference, in terms of white-matter integrity, between the groups of SLE patients.
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Affiliation(s)
- Diogo G Corrêa
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.,2 Clínica de Diagnóstico por Imagem, Brazil
| | - Nicolle Zimmermann
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.,3 Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Rafael S Borges
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
| | - Denis B Pereira
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
| | | | - Gustavo Tukamoto
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.,2 Clínica de Diagnóstico por Imagem, Brazil
| | - Rochele P Fonseca
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.,3 Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Emerson L Gasparetto
- 1 Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.,2 Clínica de Diagnóstico por Imagem, Brazil
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19
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Kalinowska-Lyszczarz A, Pawlak MA, Pietrzak A, Pawlak-Bus K, Leszczynski P, Puszczewicz M, Paprzycki W, Kozubski W, Michalak S. Distinct regional brain atrophy pattern in multiple sclerosis and neuropsychiatric systemic lupus erythematosus patients. Lupus 2018; 27:1624-1635. [PMID: 29950159 DOI: 10.1177/0961203318781004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Differentiation of systemic lupus erythematosus (SLE) from multiple sclerosis (MS) can be challenging, especially when neuropsychiatric (NP) symptoms are accompanied by white matter lesions in the brain. Given the lack of discriminative power of currently applied tools for their differentiation, there is an unmet need for other measures that can aid in distinguishing between the two autoimmune disorders. In this study we aimed at exploring whether brain atrophy measures could serve as markers differentiating MS and SLE. Thirty-seven relapsing-remitting MS and 38 SLE patients with nervous system manifestations, matched according to age and disease duration, underwent 1.5 Tesla magnetic resonance imaging (MRI), including volumetric sequences, and clinical assessment. Voxelwise analysis was performed using ANTS-SyN elastic registration protocol, FSL Randomise and Gamma methods. Cortical and subcortical segmentation was performed with Freesurfer 5.3 pipeline using T1-weighted MPRAGE sequence data. Using MRI volumetric markers of general and subcortical gray matter atrophy and clinical variables, we built a stepwise multivariable logistic diagnostic model to identify MRI parameters that best differentiate MS and SLE patients. We found that the best volumetric predictors to distinguish them were: fourth ventricle volume (sensitivity 0.86, specificity 0.57, area under the curve, AUC 0.77), posterior corpus callosum (sensitivity 0.81, specificity 0.57, AUC 0.68), and third ventricle to thalamus ratio (sensitivity 0.42, specificity 0.84, AUC 0.65). The same classifiers were identified in a subgroup analysis that included patients with a short disease duration. In MS brain atrophy and lesion load correlated with clinical disability, while in SLE age was the main determinant of brain volume. This study proposes new imaging parameters for differential diagnosis of MS and SLE with central nervous system involvement. We show there is a different pattern of atrophy in MS and SLE, and the key structural volumes that are differentially affected include fourth ventricle and posterior section of corpus callosum, followed by third ventricle to thalamus ratio. Different correlation patterns between volumetric and clinical data may suggest that while in MS atrophy is driven mainly by disease activity, in SLE it is mostly associated with age. However, these results need further replication in a larger cohort.
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Affiliation(s)
- A Kalinowska-Lyszczarz
- 1 Division of Neurochemistry and Neuropathology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - M A Pawlak
- 2 Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poznan, Poland
| | - A Pietrzak
- 3 Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - K Pawlak-Bus
- 4 Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
| | - P Leszczynski
- 4 Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
| | - M Puszczewicz
- 5 Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - W Paprzycki
- 6 Department of Neuroradiology, Poznan University of Medical Sciences, Poznan, Poland
| | - W Kozubski
- 3 Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - S Michalak
- 1 Division of Neurochemistry and Neuropathology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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20
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Cannerfelt B, Nystedt J, Jönsen A, Lätt J, van Westen D, Lilja A, Bengtsson A, Nilsson P, Mårtensson J, Sundgren PC. White matter lesions and brain atrophy in systemic lupus erythematosus patients: correlation to cognitive dysfunction in a cohort of systemic lupus erythematosus patients using different definition models for neuropsychiatric systemic lupus erythematosus. Lupus 2018. [DOI: 10.1177/0961203318763533] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aim The aim of this study was to evaluate the extent of white matter lesions, atrophy of the hippocampus and corpus callosum, and their correlation with cognitive dysfunction (CD), in patients diagnosed with systemic lupus erythematosus (SLE). Methods Seventy SLE patients and 25 healthy individuals (HIs) were included in the study. To evaluate the different SLE and neuropsychiatric SLE (NPSLE) definition schemes, patients were grouped both according to the American College of Rheumatology (ACR) definition, as well as the more stringent ACR-Systemic Lupus International Collaborating Clinics definition. Patients and HIs underwent a 3 Tesla brain MRI and a standardized neuropsychological test. MRI data were evaluated for number and volume of white matter lesions and atrophy of the hippocampus and corpus callosum. Differences between groups and subgroups were evaluated for significance. Number and volume of white matter lesions and atrophy of the hippocampus and corpus callosum were correlated to cognitive dysfunction. Results The total volume of white matter lesions was significantly larger in SLE patients compared to HIs ( p = 0.004). However, no significant differences were seen between the different SLE subgroups. Atrophy of the bilateral hippocampus was significantly more pronounced in patients with NPSLE compared to those with non-NPSLE (right: p = 0.010; left p = 0.023). Significant negative correlations between cognitive test scores on verbal memory and number and volume of white matter lesions were present. Conclusion SLE patients have a significantly larger volume of white matter lesions on MRI compared to HIs and the degree of white matter lesion volume correlates to cognitive dysfunction, specifically to verbal memory. No significant differences in the number or volume of white matter lesions were identified between subgroups of SLE patients regardless of the definition model used.
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Affiliation(s)
- B Cannerfelt
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
| | - J Nystedt
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Clinical Sciences, Center for Imaging and Function, Skåne University hospital, Lund, Sweden
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - A Jönsen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - J Lätt
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - D van Westen
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Clinical Sciences, Center for Imaging and Function, Skåne University hospital, Lund, Sweden
| | - A Lilja
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
| | - A Bengtsson
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - P Nilsson
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - J Mårtensson
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
| | - P C Sundgren
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Clinical Sciences, Center for Imaging and Function, Skåne University hospital, Lund, Sweden
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21
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Liu S, Cheng Y, Zhao Y, Yu H, Lai A, Lv Z, Xu X, Luo C, Shan B, Xu L, Xu J. Clinical Factors Associated with Brain Volume Reduction in Systemic Lupus Erythematosus Patients without Major Neuropsychiatric Manifestations. Front Psychiatry 2018; 9:8. [PMID: 29449817 PMCID: PMC5799237 DOI: 10.3389/fpsyt.2018.00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/12/2018] [Indexed: 01/11/2023] Open
Abstract
The aim of the study was to find structural brain changes in systemic lupus erythematosus patients without major neuropsychiatric manifestations [non-neuropsychiatric systemic lupus erythematosus (non-NPSLE)] using quantitative magnetic resonance imaging (MRI) and possible associations with clinical characteristics. 89 non-NPSLE patients with normal conventional MRI and 84 healthy controls (HCs) were recruited. The whole brain gray matter volume (GMV) and white matter volume (WMV) were calculated for each individual. We found obvious GMV and WMV reduction in the systemic lupus erythematosus (SLE) group compared with HCs. Female patients showed significant reduction of GMV and WMV compared with male patients. Patients treated with immunosuppressive agents (ISA) showed less WMV reduction than those without. Cognitive impairment was the most common subclinical neuropsychiatric manifestation and had a prevalence of 46.1%. Association between WMV reduction with cognitive impairment was found. Thus, we concluded that structural brain atrophy could happen even before occurrence of obvious neuropsychiatric signs and symptoms and was associated with subclinical symptoms such as cognitive impairment. ISA treatment might have a protective effect on the brain atrophy. Early treatment might prevent the progressive damage to the brain. More studies are needed to fully understand the complicated underlying mechanisms of brain atrophy in SLE.
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Affiliation(s)
- Shuang Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yueyin Zhao
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongjun Yu
- Magnetic Resonance Imaging Center, The First Hospital of Kunming, Kunming, China
| | - Aiyun Lai
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhaoping Lv
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chunrong Luo
- Magnetic Resonance Imaging Center, The First Hospital of Kunming, Kunming, China
| | - Baoci Shan
- Key Laboratory of Nuclear Analysis, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Lin Xu
- Key Laboratory of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Jian Xu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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22
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Hussein MA, Elsabagh YA, Hosny A, Elgendy H. Silent cerebral MRI findings in lupus nephritis patients: Is it clinically significant? J Adv Res 2018; 9:63-67. [PMID: 30046487 PMCID: PMC6057235 DOI: 10.1016/j.jare.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 11/19/2022] Open
Abstract
Lupus nephritis (LN) carries high morbidity and mortality and whenever added to neuropsychiatric manifestations lead to more unfavorable prognosis. Though silent brain MRI findings in systemic lupus erythematosus (SLE) had been widely studied, the current work focused on LN patients comparing them to those without kidney affection, studying their cerebral MRI and its correlation with the histopathological classes of LN and disease activity. This may enable us to know more about early brain affection in LN patients for better follow up, management, and prognosis of this serious comorbidity. Cerebral MRI and MRA were studied in 40 SLE patients without neuropsychiatric manifestations; 20 LN patients with different histopathological classes and 20 patients without kidney affection. Disease activity was assessed for all patients using SLE disease activity index (SLEDAI). Abnormal MRI brain findings were more common in LN patients “though non significant” (P = 0.9). The most common lesions were white matter hyperintense lesions (WMHLs). Number and size of such lesions were significantly higher in LN patients (1.8 fold that of non nephritis, P = 0.003 and 0.03, respectively) and positively correlated with urea, creatinine, urinary albumin/creatinine ratio, SLEDAI, ESR, CRP, and grades of renal biopsy and negatively correlated with C3 and C4. Cortical atrophy and prepontine space dilatation were also significantly higher in LN patients (P = 0.01). Asymptomatic MRI brain lesions whenever present in LN patients, they are usually clinically significant and well correlate to laboratory parameters of LN, grades of renal biopsy, and disease activity independent to age, sex and hypertension.
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Affiliation(s)
- Mohamed A. Hussein
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
- Corresponding author.
| | - Yumn A. Elsabagh
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hosny
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala Elgendy
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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23
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Brain magnetic resonance imaging, cerebrospinal fluid, and autoantibody profile in 118 patients with neuropsychiatric lupus. Clin Rheumatol 2017; 37:227-233. [DOI: 10.1007/s10067-017-3891-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 10/10/2017] [Accepted: 10/24/2017] [Indexed: 11/08/2022]
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Postal M, Lapa AT, Reis F, Rittner L, Appenzeller S. Magnetic resonance imaging in neuropsychiatric systemic lupus erythematosus: current state of the art and novel approaches. Lupus 2017; 26:517-521. [PMID: 28394232 DOI: 10.1177/0961203317691373] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus is a chronic, inflammatory, immune-mediated disease affecting 0.1% of the general population. Neuropsychiatric manifestations in systemic lupus erythematosus have been more frequently recognized and reported in recent years, occurring in up to 75% of patients during the disease course. Magnetic resonance imaging is known to be a useful tool for the detection of structural brain abnormalities in neuropsychiatric systemic lupus erythematosus patients because of the excellent soft-tissue contrast observed with MRI and the ability to acquire multiplanar images. In addition to conventional magnetic resonance imaging techniques to evaluate the presence of atrophy and white matter lesions, several different magnetic resonance imaging techniques have been used to identify microstructural or functional abnormalities. This review will highlight different magnetic resonance imaging techniques, including the advanced magnetic resonance imaging methods used to determine central nervous system involvement in systemic lupus erythematosus.
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Affiliation(s)
- M Postal
- 1 Autoimmunity Lab, State University of Campinas, Brazil
| | - A Tamires Lapa
- 1 Autoimmunity Lab, State University of Campinas, Brazil
| | - F Reis
- 2 Department of Neurology, State University of Campinas, Brazil.,3 Department of Medicine, Rheumatology Unit, State University of Campinas, Brazil
| | - L Rittner
- 4 Faculty of Medical Engineering, State University of Campinas, Brazil
| | - S Appenzeller
- 2 Department of Neurology, State University of Campinas, Brazil.,3 Department of Medicine, Rheumatology Unit, State University of Campinas, Brazil
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25
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Shaharir SS, Osman SS, Md Rani SA, Sakthiswary R, Said MSM. Factors associated with increased white matter hyperintense lesion (WMHI) load in patients with systemic lupus erythematosus (SLE). Lupus 2017; 27:25-32. [PMID: 28467290 DOI: 10.1177/0961203317707062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction White matter hyperintense (WMHI) lesions are the most common finding in magnetic resonance imaging (MRI) of the brain in patients with systemic lupus erythematosus (SLE). Objective The objective of this article is to determine the clinical factors associated with an increase in WMHI lesion load among SLE patients. Method A total of 83 SLE patients with MRI of the brain from National University of Malaysia Medical Centre were included. The WMHI lesion load was determined using the Scheltens score and Fazekas scale, and their distribution was divided into the deep white matter (DWMHI) and periventricular (PVH) regions. The clinical correlates of WMHI lesions were initially determined using univariate analyses and subsequently multivariable regression analyses were performed to determine the independent factors of increased WMHI lesion load. Results MRI of the brain of 46 patients who had WMHI lesions were compared with 37 patients with normal MRI. We found significant association between the presence of WMHI lesions and age, presence of cerebral infarcts, positive antiphospholipid antibody (aPL), active disease, neuropsychiatric lupus (NPSLE) and disease damage. Age, SLEDAI scores, cerebral infarcts and disease damage were significantly associated with higher DWMHI and PVH Scheltens scores. Meanwhile, patients with active lupus nephritis (LN), lower serum albumin and more severe proteinuria were associated with larger Fazekas WMHI lesions. Multivariable regression analysis revealed that the independent factors associated with presence of WMHI lesions were positive aPL and SLEDAI scores ( p < 0.05). Higher WMHI Scheltens scores in both DWMHI and PVH were associated with presence of cerebral infarct but higher PVH lesion load was significantly associated with active SLE disease. Conclusion Presence of WMHI lesions in SLE was significantly associated with cerebral infarcts, aPL and high general SLE activity, suggesting both inflammation and ischaemia as the underlying pathology of these lesions.
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Affiliation(s)
- S S Shaharir
- 1 Department of Internal Medicine/Rheumatology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - S S Osman
- 2 Department of Radiology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - S A Md Rani
- 3 Department of Internal Medicine/Neurology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - R Sakthiswary
- 1 Department of Internal Medicine/Rheumatology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - M S M Said
- 1 Department of Internal Medicine/Rheumatology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
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26
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Sarbu N, Toledano P, Calvo A, Roura E, Sarbu MI, Espinosa G, Lladó X, Cervera R, Bargalló N. Advanced MRI techniques: biomarkers in neuropsychiatric lupus. Lupus 2017; 26:510-516. [DOI: 10.1177/0961203316674820] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The objective of this study was to determine whether advanced MRI could provide biomarkers for diagnosis and prognosis in neuropsychiatric systemic lupus erythematosus (NPSLE). Methods Our prospective study included 28 systemic lupus erythematosus (SLE) patients with primary central NPSLE, 22 patients without NPSLE and 20 healthy controls. We used visual scales to evaluate atrophy and white matter hyperintensities, voxel-based morphometry and Freesurfer to measure brain volume, plus diffusion-tensor imaging (DTI) to assess white matter (WM) and gray matter (GM) damage. We compared the groups and correlated MRI abnormalities with clinical data. Results NPSLE patients had less GM and WM than controls ( p = 0.042) in the fronto-temporal regions and corpus callosum. They also had increased diffusivities in the temporal lobe WM ( p < 0.010) and reduced fractional anisotropy in the right frontal lobe WM ( p = 0.018). High clinical scores, longstanding disease, and low serum C3 were associated with atrophy, lower fractional anisotropy and higher diffusivity in the fronto-temporal lobes. Antimalarial treatment correlated negatively with atrophy in the frontal cortex and thalamus; it was also associated with lower diffusivity in the fronto-temporal WM clusters. Conclusions Atrophy and microstructural damage in fronto-temporal WM and GM in NPSLE correlate with severity, activity and the time from disease onset. Antimalarial treatment seems to give some brain-protective effects.
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Affiliation(s)
- N Sarbu
- Department of Neuroradiology, Hospital Clinic, Barcelona, Spain
- Department of Magnetic Resonance Imaging and Neuroradiology, Erasme University of Brussels (ULB), Brussels, Belgium
| | - P Toledano
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - A Calvo
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
| | - E Roura
- Computer Vision and Robotics Group, University of Girona, Girona, Spain
| | - M I Sarbu
- Department of Rheumatology, Centre Hospitaliere Universitaire (CHU) Saint-Pierre and Erasme Hospital, ULB, Brussels, Belgium
| | - G Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - X Lladó
- Computer Vision and Robotics Group, University of Girona, Girona, Spain
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - N Bargalló
- Department of Neuroradiology, Hospital Clinic, Barcelona, Spain
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Spain
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27
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Bódi N, Polgár A, Kiss E, Mester Á, Poór G, Kéri S. Reduced volumes of the CA1 and CA4-dentate gyrus hippocampal subfields in systemic lupus erythematosus. Lupus 2017; 26:1378-1382. [PMID: 28355989 DOI: 10.1177/0961203317701845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction There is evidence for hippocampal dysfunctions in systemic lupus erythematosus (SLE), which may contribute to neuropsychiatric impairments. However, fine structural alterations of the hippocampus have not been investigated in SLE. Methods We measured the volume of hippocampal subfields in 18 SLE patients and 20 healthy control individuals matched for age, gender, and education. The MRI protocol included structural T1 volumes (Philips Achieva 3T scanner, magnetization-prepared rapid acquisition gradient echo (MPRAGE)). For image processing, we used the neuGRID platform and the longitudinal pipeline of FreeSurfer v6.0 with the "hipposubfields" flag. Results Patients with SLE showed reduced volumes of CA1 (Cornu Ammonis 1) and CA4-dentate gyrus subfields relative to the control individuals. Smaller CA1 volumes were associated with worse performance on the Addenbrooke's Cognitive Examination. Conclusions These preliminary results indicate a prominent vulnerability and functional relevance of the CA1 hippocampal subfield in SLE.
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Affiliation(s)
- N Bódi
- 1 National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - A Polgár
- 1 National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - E Kiss
- 1 National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.,2 Rheumatology Division of Third Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Á Mester
- 1 National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - G Poór
- 1 National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.,2 Rheumatology Division of Third Department of Medicine, Semmelweis University, Budapest, Hungary
| | - S Kéri
- 3 Budapest University of Technology and Economics, Department of Cognitive Science, Budapest, Hungary.,4 Nyírő Gyula Hospital-National Institute of Psychiatry and Addictions, Budapest, Hungary.,5 University of Szeged, Department of Physiology, Szeged, Hungary
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28
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Faria R, Gonçalves J, Dias R. Neuropsychiatric Systemic Lupus Erythematosus Involvement: Towards a Tailored Approach to Our Patients? Rambam Maimonides Med J 2017; 8:RMMJ.10276. [PMID: 28178431 PMCID: PMC5298362 DOI: 10.5041/rmmj.10276] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) is a complex condition that remains poorly understood, and includes heterogeneous manifestations involving both the central and peripheral nervous system, with disabling effects. There are several models to improve NPSLE diagnosis when a neurological syndrome is present. In the last couple of years, the growing knowledge of the role of cytokines and antibodies in NPSLE, as well as the development of new functional imaging techniques, has brought some insights into the physiopathology of the disease, but their validation for clinical use remains undetermined. Furthermore, besides the classic clinical approach, a new tool for screening the 19 NPSLE syndromes has also been developed. Regarding NPSLE therapeutics, there is still no evidence-based treatment approach, but some data support the safety of biological medication when classic treatment fails. Despite the tendency to reclassify SLE patients in clinical and immunological subsets, we hope that these data will inspire medical professionals to approach NPSLE in a manner more tailored to the individual patient.
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Affiliation(s)
- Raquel Faria
- Clinical Immunology Unit, Centro Hospitalar do Porto, Porto, Portugal
- To whom correspondence should be addressed. E-mail:
| | - João Gonçalves
- Medical Service, Centro Hospitalar do Porto, Porto, Portugal
| | - Rita Dias
- Medical Service, Centro Hospitalar do Porto, Porto, Portugal
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29
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Karaaslan Z, Ekizoğlu E, Tektürk P, Erdağ E, Tüzün E, Bebek N, Gürses C, Baykan B. Investigation of neuronal auto-antibodies in systemic lupus erythematosus patients with epilepsy. Epilepsy Res 2017; 129:132-137. [DOI: 10.1016/j.eplepsyres.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/30/2016] [Accepted: 12/13/2016] [Indexed: 11/25/2022]
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30
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Wiseman SJ, Bastin ME, Jardine CL, Barclay G, Hamilton IF, Sandeman E, Hunt D, Amft EN, Thomson S, Belch JFF, Ralston SH, Wardlaw JM. Cerebral Small Vessel Disease Burden Is Increased in Systemic Lupus Erythematosus. Stroke 2016; 47:2722-2728. [PMID: 27703087 PMCID: PMC5079231 DOI: 10.1161/strokeaha.116.014330] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/24/2016] [Indexed: 01/02/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Systemic lupus erythematosus (SLE) increases stroke risk, but the mechanism is uncertain. This study aimed to determine the association between SLE and features on neuroimaging of cerebral small vessel disease (SVD), a risk factor for stroke. Methods— Consecutive patients attending a clinic for SLE were recruited. All patients underwent brain magnetic resonance imaging; had blood samples taken for markers of inflammation, endothelial dysfunction, cholesterol, and autoantibodies; and underwent cognitive and psychiatric testing. The data were compared with sex- and age-matched healthy controls and patients with minor stroke. Features of SVD were measured, a total SVD score calculated, and associations sought with vascular risk factors, cognition, SLE activity, and disease duration. Results— Fifty-one SLE patients (age: 48.8 years; SD: 14.3 years) had a greater total SVD score compared with healthy controls (1 versus 0; P<0.0001) and stroke patients (1 versus 0; P=0.02). There were higher perivascular spaces and deep white matter hyperintensity scores and more superficial brain atrophy in SLE patients versus healthy controls. Despite fewer vascular risk factors than similarly aged stroke patients, SLE patients had similar or more of some SVD features. The total SVD score was not associated with SLE activity, cognition, disease duration, or any blood measure. Conclusions— In this data set, SLE patients had a high burden of SVD features on magnetic resonance imaging, particularly perivascular spaces. A larger longitudinal study is warranted to determine the causes of SVD features in SLE and clinical implications.
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Affiliation(s)
- Stewart J Wiseman
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Mark E Bastin
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Charlotte L Jardine
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Gayle Barclay
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Iona F Hamilton
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Elaine Sandeman
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - David Hunt
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - E Nicole Amft
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Susan Thomson
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Jill F F Belch
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Stuart H Ralston
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.)
| | - Joanna M Wardlaw
- From the Centre for Clinical Brain Sciences (S.J.W., M.E.B., C.L.J., G.B., I.F.H., E.S., D.H., J.M.W.) and Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, United Kingdom; Department of Rheumatology, Western General Hospital, Edinburgh, United Kingdom (E.N.A.); and Division of Cardiovascular and Diabetes Medicine, University of Dundee, United Kingdom (S.T., J.F.F.B.).
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Al-Obaidi M, Saunders D, Brown S, Ramsden L, Martin N, Moraitis E, Pilkington CA, Brogan PA, Eleftheriou D. Evaluation of magnetic resonance imaging abnormalities in juvenile onset neuropsychiatric systemic lupus erythematosus. Clin Rheumatol 2016; 35:2449-56. [PMID: 27527090 PMCID: PMC5031744 DOI: 10.1007/s10067-016-3376-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/02/2016] [Indexed: 10/25/2022]
Abstract
The aim of this study was to describe the abnormalities identified with conventional MRI in children with neuropsychiatric systemic lupus erythematosus (NPSLE). This was single-centre (Great Ormond Street Hospital, London) retrospective case series of patients with juvenile NPSLE seen in 2003-2013. Brain MR images of the first episode of active NPSLE were reviewed. All patients fulfilled the 1999 ACR case definitions for NPSLE syndromes. Presenting neuropsychiatric manifestations, immunological findings and treatment are reported. Results are expressed as median and ranges or percentages. Fisher's exact test was used to identify clinical predictors of abnormal MRI. A total of 27 patients (22 females), median age 11 years (4-15), were identified. Presenting clinical symptoms included the following: headaches (85.1 %), mood disorder/depression (62.9 %), seizures (22.2 %), acute psychosis (18.5 %), cognitive dysfunction (14.8 %), movement disorder (14.8 %), acute confusional state (14.8 %), aseptic meningitis (7.4 %), demyelinating syndrome (3.7 %), myelopathy (3.7 %), dysautonomia (3.7 %) and cranial neuropathy (3.7 %). The principal MR findings were as follows: (1) absence of MRI abnormalities despite signs and symptoms of active NPSLE (59 %); (2) basilar artery territory infarction (3 %); (3) focal white matter hyperintensities on T2-weighted imaging (33 %); (4) cortical grey matter lesions (3 %); and (5) brain atrophy (18.5 %). The presence of an anxiety disorder strongly associated with abnormal MRI findings (p = 0.008). In over half the children with NPSLE, no conventional MRI abnormalities were observed; white matter hyperintensities were the most commonly described abnormalities. Improved MR techniques coupled with other alternative diagnostic imaging modalities may improve the detection rate of brain involvement in juvenile NPSLE.
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Affiliation(s)
- M Al-Obaidi
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Saunders
- Radiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S Brown
- Radiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - L Ramsden
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - N Martin
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - E Moraitis
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - C A Pilkington
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - P A Brogan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Institute of Child Health, London, WC1E1HN, UK
| | - D Eleftheriou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Institute of Child Health, London, WC1E1HN, UK.
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32
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Roura E, Sarbu N, Oliver A, Valverde S, González-Villà S, Cervera R, Bargalló N, Lladó X. Automated Detection of Lupus White Matter Lesions in MRI. Front Neuroinform 2016; 10:33. [PMID: 27570507 PMCID: PMC4981618 DOI: 10.3389/fninf.2016.00033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/25/2016] [Indexed: 01/14/2023] Open
Abstract
Brain magnetic resonance imaging provides detailed information which can be used to detect and segment white matter lesions (WML). In this work we propose an approach to automatically segment WML in Lupus patients by using T1w and fluid-attenuated inversion recovery (FLAIR) images. Lupus WML appear as small focal abnormal tissue observed as hyperintensities in the FLAIR images. The quantification of these WML is a key factor for the stratification of lupus patients and therefore both lesion detection and segmentation play an important role. In our approach, the T1w image is first used to classify the three main tissues of the brain, white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF), while the FLAIR image is then used to detect focal WML as outliers of its GM intensity distribution. A set of post-processing steps based on lesion size, tissue neighborhood, and location are used to refine the lesion candidates. The proposal is evaluated on 20 patients, presenting qualitative, and quantitative results in terms of precision and sensitivity of lesion detection [True Positive Rate (62%) and Positive Prediction Value (80%), respectively] as well as segmentation accuracy [Dice Similarity Coefficient (72%)]. Obtained results illustrate the validity of the approach to automatically detect and segment lupus lesions. Besides, our approach is publicly available as a SPM8/12 toolbox extension with a simple parameter configuration.
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Affiliation(s)
- Eloy Roura
- Department of Computer Architecture and Technology, University of Girona Girona, Spain
| | - Nicolae Sarbu
- Centre de Diagnòstic per la Imatge, Hospital Clínic Barcelona, Spain
| | - Arnau Oliver
- Department of Computer Architecture and Technology, University of Girona Girona, Spain
| | - Sergi Valverde
- Department of Computer Architecture and Technology, University of Girona Girona, Spain
| | - Sandra González-Villà
- Department of Computer Architecture and Technology, University of Girona Girona, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic-Institut d'Investigació Biomèdica August Pi i Sunyer Barcelona, Spain
| | - Núria Bargalló
- Centre de Diagnòstic per la Imatge, Hospital ClínicBarcelona, Spain; Magnetic Resonance Imaging Core Facility, Institut d'Investigació Biomèdica August Pi i SunyerBarcelona, Spain
| | - Xavier Lladó
- Department of Computer Architecture and Technology, University of Girona Girona, Spain
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The diagnosis and clinical management of the neuropsychiatric manifestations of lupus. J Autoimmun 2016; 74:41-72. [PMID: 27427403 DOI: 10.1016/j.jaut.2016.06.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 06/21/2016] [Indexed: 01/03/2023]
Abstract
Neuropsychiatric (NP) involvement in Systemic Lupus Erythematosus (SLE), can be a severe and troubling manifestation of the disease that heavily impacts patient's health, quality of life and disease outcome. It is one of the most complex expressions of SLE which can affect central, peripheral and autonomous nervous system. Complex interrelated pathogenetic mechanisms, including genetic factors, vasculopathy, vascular occlusion, neuroendocrine-immune imbalance, tissue and neuronal damage mediated by autoantibodies, inflammatory mediators, blood brain barrier dysfunction and direct neuronal cell death can be all involved. About NPSLE a number of issues are still matter of debate: from classification and burden of NPSLE to attribution and diagnosis. The role of neuroimaging and new methods of investigation still remain pivotal and rapidly evolving as well as is the increasing knowledge in the pathogenesis. Overall, two main pathogenetic pathways have been recognized yielding different clinical phenotypes: a predominant ischemic-vascular one involving large and small blood vessels, mediated by aPL, immune complexes and leuko-agglutination which it is manifested with more frequent focal NP clinical pictures and a predominantly inflammatory-neurotoxic one mediated by complement activation, increased permeability of the BBB, intrathecal migration of autoantibodies, local production of immune complexes and pro-inflammatory cytokines and other inflammatory mediators usually appearing as diffuse NP manifestations. In the attempt to depict a journey throughout NPSLE from diagnosis to a reasoned therapeutic approach, classification, epidemiology, attribution, risk factors, diagnostic challenges, neuroimaging techniques and pathogenesis will be considered in this narrative review based on the most relevant and recent published data.
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Abe G, Kikuchi H, Arinuma Y, Hirohata S. Brain MRI in patients with acute confusional state of diffuse psychiatric/neuropsychological syndromes in systemic lupus erythematosus. Mod Rheumatol 2016; 27:278-283. [PMID: 27319397 DOI: 10.1080/14397595.2016.1193966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study is to explore the characteristics of brain MRI abnormalities in acute confusional state (ACS) in neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS Thirty-six patients with ACS admitted to our institutions from 1992 to 2015 were exhaustively enrolled. Their medical charts and brain MRI scans were reviewed. RESULTS Eighteen of 36 ACS patients had MRI abnormalities, mostly high-intensity lesions of various sizes in the cerebral white matter. MRI abnormalities improved after treatment in 12 of 14 patients in follow-up studies. MRI abnormalities were not correlated with ages at the onset of ACS, disease durations of SLE, the presence of anti-DNA, anti-phospholipid or anti-ribosomal P antibodies, or IL-6 levels in sera or cerebrospinal fluid. Notably, MRI abnormalities were significantly associated with the presence of serum anti-Sm antibodies (p = 0.0067). Finally, eight of the 18 patients with MRI abnormalities, but none of the other 18 patients without MRI abnormalities, died from active SLE. Thus, MRI abnormalities significantly increased the mortality in ACS (p = 0.0013, HR =10.36 [95% CI: 2.487-43.19]). CONCLUSION These results demonstrate that patients with ACS with MRI abnormalities have more severe diseases, resulting in poorer prognoses. The data also indicate that anti-Sm is involved in the development of MRI abnormalities in ACS.
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Affiliation(s)
- Gakuro Abe
- a Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Sagamihara , Kanagawa , Japan , and
| | - Hirotoshi Kikuchi
- b Department of Internal Medicine , Teikyo University School of Medicine , Itabashi-Ku , Tokyo , Japan
| | - Yoshiyuki Arinuma
- a Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Sagamihara , Kanagawa , Japan , and
| | - Shunsei Hirohata
- a Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Sagamihara , Kanagawa , Japan , and
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Wang PL, Harris RE, Chenevert TL, McCune WJ, Sundgren PC. Multi-voxel proton magnetic resonance spectroscopy changes in neuropsychiatric lupus patients. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: In this prospective study, we used 2D chemical shift imaging (CSI), a multi-voxel proton spectroscopy technique, to evaluate the brain metabolites on conventional magnetic resonance imaging (MRI) in normal-appearing white and grey matter in systemic lupus erythematosus (SLE) patients with neuropsychiatric symptoms (NPSLE); without neuropsychiatric symptoms (non-NPSLE); and healthy controls (HCs). Our objective was to find metabolites that discriminated NPSLE patients from the non-NPSLE and HC cohorts.Materials and methods: The study included 23 NPSLE patients, 20 non-NPSLE patients, and 21 HCs. A clinical assessment including the SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics (SLICC) scores was conducted. All patients underwent conventional MRI and 2D CSI technique to acquire the following metabolic ratios: NAA/Cr, Cho/Cr, and Cho/NAA in the anterior and posterior insula, anterior frontal and parietal white and grey matter, thalamus, basal ganglia, and occipital grey matter.Results: In terms of metabolic differences, the NPSLE patients had significant differences compared with the non-NPSLE and HC groups in the: left posterior insula (increased Cho/NAA; p = 0.008), right internal capsule (increased Cho/Cr; p < 0.05), left thalamus (increased NAA/Cr; p = 0.011), anterior grey matter (increased NAA/Cr; p = 0.004), posterior grey matter (increased Cho/NAA; p = 0.016), anterior white matter (increased NAA/Cr; p = 0.012), and left posterior white matter (increased Cho/NAA; p = 0.022). The NPSLE patients showed significantly higher SLEDAI scores (p < 0.001).Conclusion: We found several significant distinct metabolic differences between NPSLE and non-NPSLE/HC patients in various brain locations.Keywords: systemic lupus erythematosus; SLE; neuropsychiatric systemic lupus erythematosus; NPSLE; spectroscopy
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Evaluation of white matter integrity in systemic lupus erythematosus by diffusion tensor magnetic resonance imaging: a study using tract-based spatial statistics. Neuroradiology 2016; 58:819-25. [DOI: 10.1007/s00234-016-1688-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
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Wiseman SJ, Ralston SH, Wardlaw JM. Cerebrovascular Disease in Rheumatic Diseases: A Systematic Review and Meta-Analysis. Stroke 2016; 47:943-50. [PMID: 26917565 DOI: 10.1161/strokeaha.115.012052] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Some rheumatic diseases are associated with stroke. Less is known about associations with stroke subtypes or stroke risk by age. We quantified the association between stroke, its subtypes, and rheumatic diseases and identified when stroke risk is greatest. METHODS Searches of EMBASE (from 1980) and MEDLINE (from inception) to end 2014 and manual search of reference lists for studies of stroke and stroke subtypes in rheumatic diseases as well as studies measuring cerebrovascular disease from magnetic resonance imaging. RESULTS Prior published meta-analyses and new pooled analyses of any stroke in rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, gout, and psoriasis show an excess risk of stroke over the general population with odds ratio (OR) ranging from 1.51 (95% confidence interval: 1.39-1.62) to 2.13 (1.53-2.98). New meta-analyses of stroke subtypes in rheumatoid arthritis [ischemic: OR, 1.64 (1.32-2.05); hemorrhagic: OR, 1.68 (1.11-2.53)] and systemic lupus erythematosus [ischemic: OR, 2.11 (1.66-2.67); hemorrhagic: OR, 1.82 (1.07-3.09)] show an excess risk of stroke over the general population. Stroke risk across rheumatic diseases is highest in those aged <50 years [OR, 1.79 (1.46-2.20)] and reduces relatively with ageing [>65 years: OR, 1.14 (0.94-1.38); difference P<0.007]. Inflammatory arthropathies conveyed higher stroke risk than noninflammatory diseases (OR, 1.3, 1.2-1.3). It was not possible to adjust ORs for risk factors or treatments. CONCLUSIONS Risk of any stroke is higher in most rheumatic diseases than in the general population, particularly <50 years. Rheumatoid arthritis and systemic lupus erythematosus increase ischemic and hemorrhagic stroke risk by 60% to 100% relative to the general population.
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Affiliation(s)
- Stewart J Wiseman
- From the Centre for Clinical Brain Sciences, University of Edinburgh (S.J.W., J.M.W.), Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, Edinburgh, United Kingdom
| | - Stuart H Ralston
- From the Centre for Clinical Brain Sciences, University of Edinburgh (S.J.W., J.M.W.), Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- From the Centre for Clinical Brain Sciences, University of Edinburgh (S.J.W., J.M.W.), Centre for Genomic and Experimental Medicine (S.H.R.), University of Edinburgh, Edinburgh, United Kingdom.
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Parvez K, Al-Arfaj ARS, Hamdani MA, Naseeb F, Daif A, Hussain S. Pattern of MRI brain in neuro-psychiatric SLE. Effect of anti-phospholipid antibodies: A study at a tertiary care teaching hospital. Pak J Med Sci 2015; 31:1182-7. [PMID: 26649010 PMCID: PMC4641279 DOI: 10.12669/pjms.315.7975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To compare the neuro-radiologic findings in Systemic lupus erythematosus (SLE) patients with and without antiphospholipid antibodies (aPL) in different neuro-psychiatric manifestations. METHODS This cross-sectional comparative study was carried out at King Khalid University Hospital, a tertiary care teaching hospital, Riyadh, Saudi Arabia from June 2012 to January 2015. Ninety seven SLE patients with neuro-psychiatric manifestations were included in the study and divided into two groups. Group I (50 patients) SLE with aPL and group II (47 patients) SLE without aPL. We compared Demographic features, clinical manifestations and magnetic resonance imaging (MRI) brain findings. RESULTS Demographic and clinical characteristics of two groups were similar. In Group-I, anticardiolipin antibodies (aCL) were most common (86%). In patients with headache, most of the patients in Group-I had white matter hyperintensities (WMHIs) (50% vs 27%) while most of the patients in Group-II had normal MRI brain (38% vs 73%). Similarly WMHIs were found more in Group-I patients with seizures (60% vs 21%), while ischemia/infarction, atrophy and normal MRI were found in Group-II. MRI brain in patients with neurological deficit and psychiatric disorder were not much different in both the groups. CONCLUSION We found no statistically significant differences in frequencies of MRI brain abnormalities in SLE patients with and without aPL antibodies. Each of the three aPL may have a variable effect on the brain.
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Affiliation(s)
- Khalid Parvez
- Khalid Parvez, FCPS, MRCP. Registrar, Division of Rheumatology, Department of Medicine, King Khalid University Hospital (KKUH), King Saud University (KSU), Riyadh, Saudi Arabia
| | - Abdul Rahman Saud Al-Arfaj
- Abdul Rahman Saud Al-Arfaj, MRCP, FRCPC, ABIM, Professor of Rheumatology, Department of Medicine, King Khalid University Hospital (KKUH), King Saud University (KSU), Riyadh, Saudi Arabia
| | - Muhammad Afzal Hamdani
- Muhammad Afzal Hamdani, FCPS, Dip-Card., MRCP. Senior Registrar, Division of Rheumatology, Department of Medicine, King Khalid University Hospital (KKUH), King Saud University (KSU), Riyadh, Saudi Arabia
| | - Faisal Naseeb
- Faisal Naseeb, FCPS, MRCP. Registrar, Division of Rheumatology, Department of Medicine, King Khalid University Hospital (KKUH), King Saud University (KSU), Riyadh, Saudi Arabia
| | - Abdulkader Daif
- Dr. Abdulkader Daif, MD. Professor of Neurology, Department of Medicine, King Khalid University Hospital (KKUH), King Saud University (KSU), Riyadh, Saudi Arabia
| | - Sajjad Hussain
- Sajjad Hussain MD. Assistant Professor and Consultant Neuro-radiologist, Department of Radiology, King Khalid University Hospital (KKUH), King Saud University (KSU), Riyadh, Saudi Arabia
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Sarbu N, Bargalló N, Cervera R. Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus. F1000Res 2015; 4:162. [PMID: 26236469 PMCID: PMC4505788 DOI: 10.12688/f1000research.6522.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 01/24/2023] Open
Abstract
Neuropsychiatric lupus is a major diagnostic challenge, and a main cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Magnetic resonance imaging (MRI) is, by far, the main tool for assessing the brain in this disease. Conventional and advanced MRI techniques are used to help establishing the diagnosis, to rule out alternative diagnoses, and recently, to monitor the evolution of the disease. This review explores the neuroimaging findings in SLE, including the recent advances in new MRI methods.
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Affiliation(s)
- Nicolae Sarbu
- Section of Neuroradiology, Department of Radiology, Hospital Clinic, Barcelona, Catalonia, 08036, Spain
| | - Núria Bargalló
- Section of Neuroradiology, Department of Radiology, Hospital Clinic, Barcelona, Catalonia, 08036, Spain ; Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, 08036, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, 08036, Spain
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Cesar B, Dwyer MG, Shucard JL, Polak P, Bergsland N, Benedict RHB, Weinstock-Guttman B, Shucard DW, Zivadinov R. Cognitive and White Matter Tract Differences in MS and Diffuse Neuropsychiatric Systemic Lupus Erythematosus. AJNR Am J Neuroradiol 2015; 36:1874-83. [PMID: 26066628 DOI: 10.3174/ajnr.a4354] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/13/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis and neuropsychiatric systemic lupus erythematosus are autoimmune diseases with similar CNS inflammatory and neurodegenerative characteristics. Our aim was to investigate white matter tract changes and their association with cognitive function in patients with MS and those with neuropsychiatric systemic lupus erythematosus compared with healthy controls by using diffusion tensor imaging. MATERIALS AND METHODS Thirty patients with relapsing-remitting MS and 23 patients with neuropsychiatric systemic lupus erythematosus matched for disease severity and duration and 43 healthy controls were scanned with 3T MR imaging. The DTI was postprocessed, corrected for lesions, and analyzed with tract-based spatial statistics. Cognitive assessment included examination of processing speed; visual, auditory/verbal, and visual-spatial memory; and sustained attention and executive function. Differences were considered significant at P < .05. RESULTS Tract-based spatial statistics analysis revealed significantly decreased fractional anisotropy and increased mean diffusivity in patients with MS compared with healthy controls, decreased fractional anisotropy in patients with MS compared with those with neuropsychiatric systemic lupus erythematosus, and an increased mean diffusivity in patients with neuropsychiatric systemic lupus erythematosus compared with healthy controls. Patients with MS showed decreased fractional anisotropy throughout central WM pathways, including the corpus callosum and the inferior longitudinal and fronto-occipital fasciculi compared with those with neuropsychiatric systemic lupus erythematosus. Altered cognitive scores in patients with MS were significantly associated with decreased fractional anisotropy and increased mean diffusivity in all examined domains, while in patients with diffuse neuropsychiatric systemic lupus erythematosus, only decreased fractional anisotropy in the superior WM pathways showed significant association with executive function. CONCLUSIONS Patients with MS and neuropsychiatric systemic lupus erythematosus showed widespread WM tract alterations outside overt lesions, though more severe changes were identified in patients with MS. The WM tract changes were associated with cognitive dysfunction in all explored domains only in patients with MS.
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Affiliation(s)
- B Cesar
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.) Division of Cognitive and Behavioral Neurosciences (B.C., J.L.S., D.W.S.)
| | - M G Dwyer
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.) Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.)
| | - J L Shucard
- Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.) Division of Cognitive and Behavioral Neurosciences (B.C., J.L.S., D.W.S.) Neuroscience Program (J.L.S., D.W.S.)
| | - P Polak
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.)
| | - N Bergsland
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.) Magnetic Resonance Laboratory (N.B.), IRCCS Don Gnocchi Foundation, Milan, Italy
| | - R H B Benedict
- Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.)
| | | | - D W Shucard
- Department of Neurology (M.G.D., J.L.S., R.H.B.B., B.W.-G., D.W.S.) Division of Cognitive and Behavioral Neurosciences (B.C., J.L.S., D.W.S.) Neuroscience Program (J.L.S., D.W.S.)
| | - R Zivadinov
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (B.C., M.G.D., P.P., N.B., R.Z.) MRI Clinical Translational Research Center (R.Z.), School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
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Autoantibodies Affect Brain Density Reduction in Nonneuropsychiatric Systemic Lupus Erythematosus Patients. J Immunol Res 2015; 2015:920718. [PMID: 26090505 PMCID: PMC4451776 DOI: 10.1155/2015/920718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 01/15/2023] Open
Abstract
This study explores the relationship between autoantibodies and brain density reduction in SLE patients without major neuropsychiatric manifestation (NPSLE). Ninety-five NPSLE patients without obvious cerebral deficits, as determined by conventional MRI, as well as 89 control subjects, underwent high-resolution structural MRI. Whole-brain density of grey matter (GMD) and white matter (WMD) were calculated for each individual, and correlations between the brain density, symptom severity, immunosuppressive agent (ISA), and autoantibody levels were assessed. The GMD and WMD of the SLE group decreased compared to controls. GMD was negatively associated with SLE activity. The WMD of patients who received ISA treatment were higher than that in the patients who did not. The WMD of patients with anticardiolipin (ACL) or anti-SSB/La antibodies was lower than in patients without these antibodies, while the GMD was lower in patients with anti-SM or anti-U1RNP antibodies. Thus, obvious brain atrophy can occur very early even before the development of significant symptoms and specific autoantibodies might contribute to the reduction of GMD or WMD in NPSLE patients. However, ISAs showed protective effects in minimizing GMD and WMD reduction. The presence of these specific autoantibodies might help identify early brain damage in NPSLE patients.
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A multimodal MRI approach to identify and characterize microstructural brain changes in neuropsychiatric systemic lupus erythematosus. NEUROIMAGE-CLINICAL 2015; 8:337-44. [PMID: 26106559 PMCID: PMC4474280 DOI: 10.1016/j.nicl.2015.05.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/08/2015] [Accepted: 05/13/2015] [Indexed: 01/09/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease with multi-organ involvement and results in neurological and psychiatric (NP) symptoms in up to 40% of the patients. To date, the diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE) poses a challenge due to the lack of neuroradiological gold standards. In this study, we aimed to better localize and characterize normal appearing white matter (NAWM) changes in NPSLE by combining data from two quantitative MRI techniques, diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI). 9 active NPSLE patients (37 ± 13 years, all females), 9 SLE patients without NP symptoms (44 ± 11 years, all females), and 14 healthy controls (HC) (40 ± 9 years, all females) were included in the study. MTI, DTI and fluid attenuated inversion recovery (FLAIR) images were collected from all subjects on a 3 T MRI scanner. Magnetization transfer ratio (MTR), mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) maps and white matter lesion maps based on the FLAIR images were created for each subject. MTR and DTI data were then co-analyzed using tract-based spatial statistics and a cumulative lesion map to exclude lesions. Significantly lower MTR and FA and significantly higher AD, RD and MD were found in NPSLE compared to HC in NAWM regions. The differences in DTI measures and in MTR, however, were only moderately co-localized. Additionally, significant differences in DTI measures, but not in MTR, were found between NPSLE and SLE patients, suggesting that the underlying microstructural changes detected by MD are linked to the onset of NPSLE. The co-analysis of the anatomical distribution of MTI and DTI measures can potentially improve the diagnosis of NPSLE and contribute to the understanding of the underlying microstructural damage. NAWM is investigated in NPSLE and SLE using MTI and DTI. Differences in DTI and MTR between NPSLE and HC are widespread but only moderately co-localized. Significant differences in MD between SLE and NPSLE suggest link to onset of NPSLE.
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Key Words
- ACR, American College of Rheumatology
- AD, axial diffusivity
- DTI, diffusion tensor imaging
- Diffusion tensor imaging
- FA, fractional anisotropy
- FLAIR, fluid attenuated inversion recovery
- HC, healthy controls
- MD, mean diffusivity
- MTI, magnetization transfer imaging
- MTR, magnetization transfer ratio
- Magnetic resonance imaging
- Magnetization transfer imaging
- NAWM, normal appearing white matter
- NP, neurological and psychiatric
- NPSLE, neuropsychiatric systemic lupus erythematosus
- Neuropsychiatric systemic lupus erythematosus
- Normal appearing white matter
- RD, radial diffusivity
- SLE, systemic lupus erythematosus
- Systemic lupus erythematosus
- TBSS, tract based spatial statistics
- WM, white matter
- WMH, white matter hyperintensities
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Zimmermann N, Corrêa DG, Kubo TA, Netto TM, Pereira DB, Fonseca RP, Gasparetto EL. Global Cognitive Impairment in Systemic Lupus Erythematosus Patients: A Structural MRI Study. Clin Neuroradiol 2015; 27:23-29. [PMID: 25967601 DOI: 10.1007/s00062-015-0397-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/11/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study investigated differences in subcortical brain volumes of SLE patients with cognitive deficits (SLE-CD) and SLE patients with normal cognitive performance (SLE-CN), regardless of the presence of other neuropsychiatric symptoms. METHOD We studied 40 patients divided into two-matched groups (SLE-CD n = 20; SLE-CN n = 20), with age ranging from 21 to 63 years old (100 % female) and 14.73 ± 10.18 years of diagnosis. Magnetic resonance imaging exams were performed on a 1.5 T scanner. A neuropsychological flexible battery was applied individually, including reasoning/problem-solving, praxis, episodic and working memory, processing speed, language/fluency, executive functions (inhibition and flexibility), and sustained attention. Z score ≤ - 2.0 in any dimension was considered as a cut-off for being considered to possess cognitive deficits. One-way analyses of covariance (ANCOVA) were performed to compare the brain structure volumes between groups. The analyses were controlled for the effects of lupus-related neuropsychiatric disorders. RESULTS SLE patients with cognitive deficits had significantly smaller volumes in the left hippocampus, amygdala, and the right hippocampus than SLE patients without cognitive deficits. CONCLUSION SLE patients with cognitive deficits appeared to have reduced temporal lobe structures when compared with SLE without cognitive deficits. These results corroborate a systems vulnerability model that investigated temporal lobe vulnerability during normal aging and in other neurological disorders.
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Affiliation(s)
- Nicolle Zimmermann
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil.
| | - Diogo Goulart Corrêa
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil.,Department of Medical Physics, Diagnósticos da America S.A., DASA, 4666 das Américas Avenue, Barra da Tijuca, 22640-102, Rio de Janeiro, Brazil
| | - Tadeu Almodovar Kubo
- Department of Medical Physics, Diagnósticos da America S.A., DASA, 4666 das Américas Avenue, Barra da Tijuca, 22640-102, Rio de Janeiro, Brazil
| | - Tania Maria Netto
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil
| | - Denis Batista Pereira
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil
| | - Rochele Paz Fonseca
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, 6681 Ipiranga Avenue, Building 11, Partenon, 90619-900, Porto Alegre, RS, Brazil
| | - Emerson Leandro Gasparetto
- Department of Radiology, Federal University of Rio de Janeiro, Brigadeiro Trompowsky Avenue, Clementino Fraga Filho University Hospital, Room SSN29, 21941-590, Rio de Janeiro, Brazil.,Department of Medical Physics, Diagnósticos da America S.A., DASA, 4666 das Américas Avenue, Barra da Tijuca, 22640-102, Rio de Janeiro, Brazil
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Haynes BI, Bunce D, Davies KA, Rusted JM. Increased Intraindividual Reaction Time Variability in Persons with Neuropsychiatric Manifestations of Systemic Lupus Erythematosus. Arch Clin Neuropsychol 2015; 30:271-9. [DOI: 10.1093/arclin/acv006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/12/2022] Open
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Leite M, Rittner L, Appenzeller S, Ruocco HH, Lotufo R. Etiology-based classification of brain white matter hyperintensity on magnetic resonance imaging. J Med Imaging (Bellingham) 2015; 2:014002. [PMID: 26158080 DOI: 10.1117/1.jmi.2.1.014002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 01/20/2015] [Indexed: 01/17/2023] Open
Abstract
Brain white matter lesions found upon magnetic resonance imaging are often observed in psychiatric or neurological patients. Individuals with these lesions present a more significant cognitive impairment when compared with individuals without them. We propose a computerized method to distinguish tissue containing white matter lesions of different etiologies (e.g., demyelinating or ischemic) using texture-based classifiers. Texture attributes were extracted from manually selected regions of interest and used to train and test supervised classifiers. Experiments were conducted to evaluate texture attribute discrimination and classifiers' performances. The most discriminating texture attributes were obtained from the gray-level histogram and from the co-occurrence matrix. The best classifier was the support vector machine, which achieved an accuracy of 87.9% in distinguishing lesions with different etiologies and an accuracy of 99.29% in distinguishing normal white matter from white matter lesions.
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Affiliation(s)
- Mariana Leite
- University of Campinas , Faculty of Electrical and Computer Engineering, Department of Computer Engineering and Industrial Automation, Albert Einstein Avenue, 13083-852 Campinas, Brazil
| | - Letícia Rittner
- University of Campinas , Faculty of Electrical and Computer Engineering, Department of Computer Engineering and Industrial Automation, Albert Einstein Avenue, 13083-852 Campinas, Brazil
| | - Simone Appenzeller
- University of Campinas , Faculty of Medical Science, Rheumatology Division, Zeferino Vaz Avenue, 13083-970 Campinas, Brazil
| | - Heloísa Helena Ruocco
- Hospital of Faculty of Medicine of Jundiaí , Multiple Sclerosis Center, Francisco Telles Street, 13202-550 Jundiaí, Brazil
| | - Roberto Lotufo
- University of Campinas , Faculty of Electrical and Computer Engineering, Department of Computer Engineering and Industrial Automation, Albert Einstein Avenue, 13083-852 Campinas, Brazil
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Morris G, Berk M, Walder K, Maes M. Central pathways causing fatigue in neuro-inflammatory and autoimmune illnesses. BMC Med 2015; 13:28. [PMID: 25856766 PMCID: PMC4320458 DOI: 10.1186/s12916-014-0259-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/17/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The genesis of severe fatigue and disability in people following acute pathogen invasion involves the activation of Toll-like receptors followed by the upregulation of proinflammatory cytokines and the activation of microglia and astrocytes. Many patients suffering from neuroinflammatory and autoimmune diseases, such as multiple sclerosis, Parkinson's disease and systemic lupus erythematosus, also commonly suffer from severe disabling fatigue. Such patients also present with chronic peripheral immune activation and systemic inflammation in the guise of elevated proinflammtory cytokines, oxidative stress and activated Toll-like receptors. This is also true of many patients presenting with severe, apparently idiopathic, fatigue accompanied by profound levels of physical and cognitive disability often afforded the non-specific diagnosis of chronic fatigue syndrome. DISCUSSION Multiple lines of evidence demonstrate a positive association between the degree of peripheral immune activation, inflammation and oxidative stress, gray matter atrophy, glucose hypometabolism and cerebral hypoperfusion in illness, such as multiple sclerosis, Parkinson's disease and chronic fatigue syndrome. Most, if not all, of these abnormalities can be explained by a reduction in the numbers and function of astrocytes secondary to peripheral immune activation and inflammation. This is also true of the widespread mitochondrial dysfunction seen in otherwise normal tissue in neuroinflammatory, neurodegenerative and autoimmune diseases and in many patients with disabling, apparently idiopathic, fatigue. Given the strong association between peripheral immune activation and neuroinflammation with the genesis of fatigue the latter group of patients should be examined using FLAIR magnetic resonance imaging (MRI) and tested for the presence of peripheral immune activation. SUMMARY It is concluded that peripheral inflammation and immune activation, together with the subsequent activation of glial cells and mitochondrial damage, likely account for the severe levels of intractable fatigue and disability seen in many patients with neuroimmune and autoimmune diseases.This would also appear to be the case for many patients afforded a diagnosis of Chronic Fatigue Syndrome.
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Affiliation(s)
- Gerwyn Morris
- Tir Na Nog, Bryn Road seaside 87, Llanelli, SA152LW Wales UK
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Ken Walder
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, Australia
| | - Michael Maes
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Pamfil C, Fanouriakis A, Damian L, Rinzis M, Sidiropoulos P, Tsivgoulis G, Rednic S, Bertsias G, Boumpas DT. EULAR recommendations for neuropsychiatric systemic lupus erythematosusvsusual care: results from two European centres. Rheumatology (Oxford) 2015; 54:1270-8. [DOI: 10.1093/rheumatology/keu482] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Indexed: 12/22/2022] Open
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Piga M, Peltz MT, Montaldo C, Perra D, Sanna G, Cauli A, Mathieu A. Twenty-year brain magnetic resonance imaging follow-up study in Systemic Lupus Erythematosus: Factors associated with accrual of damage and central nervous system involvement. Autoimmun Rev 2015; 14:510-6. [PMID: 25617815 DOI: 10.1016/j.autrev.2015.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To evaluate the long-term progression of cerebral MRI abnormalities in patients with longstanding SLE, 30 patients (age 53.5 ± 11.3) underwent brain MRI at baseline (b-MRI) and after 19.4 ± 3.7 years of follow-up (fu-MRI). Two neuroradiologists visually analyzed the MRIs comparing: 1) white matter hyperintensities (WMHIs), 2) cerebral volume, and 3) parenchymal defects; these outcomes were also built in a modified MRI scoring system (mMSS) to estimate the cumulative parenchymal damage. The independent risk factors for accrual of MRI brain damage, as well as the association between MRI abnormalities and the development of new neuropsychiatric (NP) manifestations classified according to the 1999 ACR case definition were also analyzed. Twenty-three patients (76.7%) showed worsening of mMSS; 19 (63.3%) had increased number and volume of WMHIs, 8 (26.7%) had significant cerebral volume loss, and 6 (20%) showed new ischemic parenchymal lesions. Only 6 patients had normal MRI. Antimalarial agents (p=0.006; OR 0.08) were protective against worsening of WMHIs. High cumulative dose of corticosteroids (p=0.026; OR 8.8) and dyslipidemia (p=0.044; OR 10.1) were associated with increased mMSS and cerebral volume loss, respectively. Higher mMSS score at baseline was independently associated with worsening of WMHIs (p=0.001; OR 5.7) and development of new NP events (p=0.019; OR 2.0); higher load of deep WMHIs at b-MRI (p=0.018; OR 2.0) was independently associated with stroke risk. This study shows that MRI brain damage in SLE patients progresses independently from NP involvement as effect of potentially modifiable risk factors and it is associated with increased risk of new NP events.
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Affiliation(s)
- Matteo Piga
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
| | | | | | - Daniela Perra
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
| | - Giovanni Sanna
- Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK; Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
| | - Alberto Cauli
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
| | - Alessandro Mathieu
- Chair of Rheumatology and Rheumatology Unit, University Clinic AOU of Cagliari, Italy.
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Sarbu N, Alobeidi F, Toledano P, Espinosa G, Giles I, Rahman A, Yousry T, Capurro S, Jäger R, Cervera R, Bargalló N. Brain abnormalities in newly diagnosed neuropsychiatric lupus: systematic MRI approach and correlation with clinical and laboratory data in a large multicenter cohort. Autoimmun Rev 2014; 14:153-9. [PMID: 25461835 DOI: 10.1016/j.autrev.2014.11.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/05/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To describe brain magnetic resonance imaging (MRI) abnormalities in newly diagnosed neuropsychiatric lupus (NPSLE). To correlate them with clinical and laboratory data. METHODS This retrospective cross-sectional study included patients presenting NPSLE undergoing brain MRI within 6 months after onset between 2003 and 2012. Clinical and laboratory data were recorded. MRI findings were defined as inflammatory-like, large-vessel disease (LVD), and small-vessel disease (SVD); SVD was classified as white-matter hyperintensities (WMH), recent small subcortical infarcts, lacunes, microbleeds, and brain atrophy. RESULTS We included 108 patients (mean 40.6 ± 14.2 years; range 14-77), 91.7% women. The most frequent syndromes were headache (28.5%), cerebrovascular disease (15.5%), seizure (15.5%), and cognitive dysfunction (11.4%). Brain abnormalities were found in 59.3%. SVD was the most common (55.6%), followed by LVD (13%) and inflammatory-like lesions (6.5%). The most frequent SVD findings were WMH (53.7%), atrophy (18.5%), microbleeds (13.7%) and lacunes (11.1%). Cerebrovascular syndrome correlated with LVD (p = 0.001) and microbleeds (p = 0.002), cognitive dysfunction with WMH (p = 0.045) and myelopathy with inflammatory-like lesions (p = 0.020). Low C4 and CH50 correlated with inflammatory-like lesions (p < 0.001, p = 0.019) and lupus anticoagulant with WMH (p = 0.018), microbleeds (p = 0.002) and atrophy (p = 0.008). CONCLUSIONS Vascular disease is the hallmark of NPSLE. Certain syndromes and immunological patterns are prone to more extensive brain damage. MRI could provide significant clinical information and insights into the pathological substrate.
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Affiliation(s)
- Nicolae Sarbu
- Department of Neuroradiology, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Farah Alobeidi
- Department of Neuroradiology, The National Hospital of Neurology and Neurosurgery, London, UK
| | - Pilar Toledano
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Ian Giles
- Department of Rheumatology, University College Hospital, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, London, UK
| | - Tarek Yousry
- Department of Neuroradiology, The National Hospital of Neurology and Neurosurgery, London, UK
| | - Sebastian Capurro
- Department of Neuroradiology, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Rolf Jäger
- Department of Neuroradiology, The National Hospital of Neurology and Neurosurgery, London, UK
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Nuria Bargalló
- Department of Neuroradiology, Hospital Clinic, Barcelona, Catalonia, Spain; Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
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Arinuma Y, Kikuchi H, Wada T, Nagai T, Tanaka S, Oba H, Hirohata S. Brain MRI in patients with diffuse psychiatric/neuropsychological syndromes in systemic lupus erythematosus. Lupus Sci Med 2014; 1:e000050. [PMID: 25396069 PMCID: PMC4225739 DOI: 10.1136/lupus-2014-000050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Manifestations in neuropsychiatric systemic lupus erythematosus (NPSLE), especially active diffuse NPSLE syndromes, are some of the most difficult complications of the disease. For the evaluation and the diagnosis of central nervous system manifestations, including NPSLE, MRI is a very useful tool to detect the various abnormalities. However, the relationship between brain MRI findings and clinical variables has not yet been clarified in patients with diffuse NPSLE. OBJECTIVES The aim of this study is to investigate the pathogenesis of diffuse NPSLE, by comparing various parameters such as serum autoantibodies and cytokines in cerebrospinal fluid (CSF) with abnormal findings revealed on brain MRIs in patients with diffuse NPSLE. METHODS Fifty-three patients with diffuse NPSLE admitted to our University Hospital from 1992 to 2012 were exhaustively enrolled in this study. Their medical charts and brain MRI scans were reviewed. The relationship of MRI abnormalities with various parameters was analysed. RESULTS As many as 25 of 53 patients (47.2%) had abnormal MRI findings. MRI findings improved after treatment in 10 of 17 patients for whom follow-up studies were available. MRI abnormalities were not correlated with age at the onset of diffuse NPSLE. However, the disease duration of SLE was significantly longer in patients with abnormal MRI findings (p=0.0009). MRI abnormalities were not significantly associated with serum autoantibodies. However, there were significant elevations of the CSF protein level (p=0.0106) and the CSF interleukin 6 level (p=0.0225) in patients with abnormal MRI findings. Patients with MRI abnormalities showed significantly higher overall mortality (p=0.0348). CONCLUSIONS The results revealed that MRI abnormalities in diffuse NPSLE might be heterogeneous with regard to their reversibility. These data also indicate that patients with diffuse NPSLE and MRI abnormalities have more severe inflammation in the central nervous system related to the activity of diffuse NPSLE, as evidenced by poorer prognosis.
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Affiliation(s)
- Yoshiyuki Arinuma
- Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Kanagawa , Japan
| | - Hirotoshi Kikuchi
- Department of Internal Medicine , Teikyo University School of Medicine , Tokyo , Japan
| | - Tatsuhiko Wada
- Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Kanagawa , Japan
| | - Tatsuo Nagai
- Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Kanagawa , Japan
| | - Sumiaki Tanaka
- Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Kanagawa , Japan
| | - Hiroshi Oba
- Department of Radiology , Teikyo University Hospital , Tokyo , Japan
| | - Shunsei Hirohata
- Department of Rheumatology and Infectious Diseases , Kitasato University School of Medicine , Kanagawa , Japan
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