Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus

Sârbu, Nicolae; Bargalló, Núria; Cervera, Ricard

doi:10.12688/f1000research.6522.2

Cited by 27 publications

(31 citation statements)

References 86 publications

(142 reference statements)

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“…It is crucial to differentiate NPSLE from SLE without neurologic or psychiatric symptoms (named non‐NPSLE; Sarbu et al, ). However, the discrimination of NPSLE from non‐NPSLE is difficult in a clinical setting, requiring stable and reliable biological and radiographical markers (Castellino, Govoni, Giacuzzo, & Trotta, ; Cervera et al, ; Sarbu, Bargalló, & Cervera, ).…”

Section: Introductionmentioning

confidence: 99%

Different patterns of cerebral perfusion in SLE patients with and without neuropsychiatric manifestations

Zhuo

Duan

et al. 2019

Human Brain Mapping

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To investigate brain perfusion patterns in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric systemic lupus erythematosus (NPSLE and non-NPSLE, respectively) and to identify biomarkers for the diagnosis of NPSLE using noninvasive three-dimensional (3D) arterial spin labeling (ASL). Thirty-one NPSLE and 24 non-NPSLE patients and 32 age-and sex-matched normal controls (NCs) were recruited. Three-dimensional ASL-MRI was applied to quantify cerebral perfusion. Whole brain, gray (GM) and white matter (WM), and voxel-based analysis (VBA) were performed to explore perfusion characteristics. Correlation analysis was performed to find the relationship between the perfusion measures, lesion volumes, and clinical variables. Receiver operating characteristic (ROC) analysis and support vector machine (SVM) classification were applied to differentiate NPSLE patients from non-NPSLE patients and healthy controls. Compared to NCs, NPSLE patients showed increased cerebral blood flow (CBF) within WM but decreased CBF within GM, while non-NPSLE patients showed increased CBF within both GM and WM. Compared to non-NPSLE patients, NPSLE patients showed significantly reduced CBF in the frontal gyrus, cerebellum, and corpus callosum. CBF within several brain regions such as cingulate and corpus callosum showed significant correlations with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborating Clinics (SLICC) damage index scores. ROC analysis showed moderate performance in distinguishing NPSLE from non-NPSLE patients with AUCs > 0.7, while SVM analysis demonstrated that CBF within the corpus callosum achieved an accuracy of 83.6% in distinguishing NPSLE from non-NPSLE patients. Different brain perfusion patterns were observed between NPSLE and non-NPSLE patients. CBF measured by noninvasive 3D ASL could be a useful biomarker for the diagnosis and disease monitoring of NPSLE and non-NPSLE patients. K E Y W O R D S 3D arterial spin labeling, neuropsychiatric systemic lupus erythematosus, perfusion, systemic lupus erythematosus Zhizheng Zhuo and Li Su contributed equally to this study.

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Section: Introductionmentioning

confidence: 99%

Different patterns of cerebral perfusion in SLE patients with and without neuropsychiatric manifestations

Zhuo

Duan

et al. 2019

Human Brain Mapping

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“…WML occur in 40-60% of NPSLE patients, even at the earliest stages of the disease. [30][31][32][33] The known risk factors for WML in NPSLE include age, duration of NP symptoms and total cumulated steroid dose, 34 and total WML volume correlates with disease activity measured with SLEDAI score and Damage Index. It has even been suggested that WML may serve as a predictive factor, useful for monitoring disease progression and response to therapy.…”

Section: Discussionmentioning

confidence: 99%

“…It has even been suggested that WML may serve as a predictive factor, useful for monitoring disease progression and response to therapy. 33,34 However, WML identification and even quantitative description has poor discriminative value for MS and SLE, mainly because of its non-specific character and a variety of confounding factors (i.e. coexistence of other diseases that cause WM pathology, such as hypertension or atherosclerosis).…”

Section: Discussionmentioning

confidence: 99%

Distinct regional brain atrophy pattern in multiple sclerosis and neuropsychiatric systemic lupus erythematosus patients

Kalinowska-Łyszczarz

Pawlak

Pietrzak

et al. 2018

Lupus

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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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“…Many factors contribute to the presence of WMH on MRI, including age, hypertension, diabetes mellitus and dyslipidaemia. 29 In patients with SLE, WMH may occur in the absence of NPSLE. However, in patients with NPSLE, age, duration of neuropsychiatric manifestations and cumulative steroid dosage are independent predictors of WMH.…”

Section: Mri Findings In Patients With Npslementioning

confidence: 99%

Clinical, neuroimaging and immunological phenotype of South African neuropsychiatric systemic lupus erythematosus patients

Mvambo

Bhigjee

Mody

2019

Lupus

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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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Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus

Cited by 27 publications

References 86 publications

Different patterns of cerebral perfusion in SLE patients with and without neuropsychiatric manifestations

Different patterns of cerebral perfusion in SLE patients with and without neuropsychiatric manifestations

Distinct regional brain atrophy pattern in multiple sclerosis and neuropsychiatric systemic lupus erythematosus patients

Clinical, neuroimaging and immunological phenotype of South African neuropsychiatric systemic lupus erythematosus patients

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