Objective. The clinical manifestations of nervous system involvement in systemic lupus erythematosus (neuropsychiatric SLE [NPSLE]) are highly diverse, and their etiology is incompletely understood. The aim of this study was to provide an inventory of abnormalities on conventional brain magnetic resonance imaging (MRI) in NPSLE and to interpret the findings in relation to possible underlying pathogenetic mechanisms.Methods. MR images of the first episode of active NPSLE in 74 patients were retrospectively reviewed. All patients fulfilled the American College of Rheumatology (ACR) 1982 revised criteria for the classification of SLE and were classified according to the 1999 ACR case definitions for NPSLE syndromes. We excluded patients with a history of brain disease and patients in whom other mechanisms unrelated to SLE caused the neuropsychiatric symptoms.Results. The principal findings were: 1) focal hyperintensities in white matter (WM) (49% of all patients) or both WM and gray matter (GM) (5% of all patients), suggestive of vasculopathy or vasculitis; 2) more widespread, confluent hyperintensities in the WM, suggestive of chronic hypoperfusion due to the same mechanisms; 3) diffuse cortical GM lesions (12% of all patients), compatible with an immune response to neuronal components or postseizure changes; and 4) absence of MRI abnormalities, despite signs and symptoms of active disease (42% of all patients).Conclusion. Several distinct brain MRI patterns were observed in patients with active NPSLE, suggestive of different pathogenetic mechanisms. To advance our understanding of the various processes leading to NPSLE, the radiographic manifestations may be a good starting point and useful for categorization of patients in further research.In the course of their disease, many patients with systemic lupus erythematosus (SLE) develop neurologic or psychiatric symptoms. After exclusion of other causes such as concomitant illnesses, infection, or drug side effects, these neuropsychiatric manifestations are attributed to involvement of the nervous system in SLE, which is referred to as neuropsychiatric SLE (NPSLE) (1). Correct attribution of neuropsychiatric events to NPSLE or to an alternative etiology is a challenge, given the absence of a diagnostic gold standard for NPSLE. In clinical practice, NPSLE is a diagnosis per exclusionem, achieved case-by-case using clinical, laboratory, and imaging data (1,2). Consequently, the diagnosis is inevitably presumptive. Magnetic resonance imaging (MRI) is the imaging technique of choice in the diagnosis of NPSLE (2,3). It is widely available and permits identification of lesions associated with NPSLE and many differential disorders.NPSLE comprises a wide range of clinical conditions affecting the central, peripheral, or autonomic nervous system, such as cognitive dysfunction, psychosis, depression, and acute confusional state, as well as more focal syndromes, such as stroke, seizures, chorea, or transverse myelitis (4). The severity of the symptoms is also highly variable. T...

Purpose: To assess whether magnetization transfer imaging (MTI) parameters change in correspondence with clinical changes in NPSLE patients. Materials and Methods:Nineteen female patients (mean age ϭ 37.5 years, range ϭ 19 -64) underwent MTI on at least two separate occasions (mean time between scans ϭ 25.4 months, range ϭ 5.4 -52.3 months). Twenty-four pairs of scans of 19 patients were available. Each patient's clinical course was classified as improved, stable, or deteriorated. Whole-brain magnetization transfer ratio (MTR) histograms were generated. The peak height of these histograms was used as an estimate of parenchymal integrity. Based on the change in clinical status, paired examinations were grouped and tested for significant differences between the first and second examinations using paired-samples t-tests. Results:Four patients clinically deteriorated, all patients showed a significant peak height decrease (mean decrease ϭ 8.6%, P ϭ 0.02), and in 14 patients with stable disease the peak height did not change significantly (mean increase ϭ 0.4%). Six patients clinically improved, and all showed a significant relative peak height increase (mean increase ϭ 12.0%, P ϭ 0.02). Conclusion:The peak height of whole-brain MTR histograms corresponds to changes in the clinical status of individual NPSLE patients. This suggests that MTI can be a valuable tool in the clinical assessment of such patients.