Neuropsychiatric systemic lupus erythematosus: Tools for the diagnosis

Zardi, Enrico Maria; Taccone, A.; Marigliano, Benedetta; Margiotta, Domenico Paolo Emanuele; Afeltra, Antonella

doi:10.1016/j.autrev.2014.04.002

Cited by 62 publications

(82 citation statements)

References 136 publications

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“…The role of other imaging modalities such as computer tomography (CT) is essentially to rule out acute complications such as hemorrhage or large infarcts, or to assess differential diagnoses 5, 19, 20 . The large spectrum of clinical presentations, laboratory and pathological findings in NPSLE made the neuroradiological findings nonspecific, a wide range of abnormalities being described 8, 21 .…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging in Neuropsychiatric Lupus

2015

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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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Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging in Neuropsychiatric Lupus

2015

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“…Third, there is a chance that some of the NPSLE syndromes may (e.g. anxiety) develop later 19 Luyendijk et al 20 and Jennings et al 21 Fluid-attenuated inversion recovery (FLAIR)…”

Section: Study Eligibility and Identificationmentioning

confidence: 99%

“…Demyelination, ischaemia and oedema major contributors to changes in magnetisation transfer ratio (MTR) and reduced histogram peak heights Zardi et al, 19 Ercana et al 23 and Bosma et al 24 Magnetic resonance spectroscopy (MRS)…”

Section: Magnetisation Transfer Imaging (Mti)mentioning

confidence: 99%

“…SPECT studies have demonstrated a higher sensitivity in patients with diffuse neurological involvement compared with MRI. 19,26,27 However, the cost and limited availability of SPECT and PET and the need for better standardisation and validation for interpretation of advanced quantitative MRI protocols have prevented their establishment in routine clinical practice thus far. 15,28,29 For this reason, the focus of our study was conventional MRI.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, more advanced imaging tools, such as the MRI methods of magnetisation transfer imaging (MTI), diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI), and methods using radioactive tracers, such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT), have been increasingly studied. 15,19 Furthermore, the EULAR task force has recommended the use of advanced imaging in cases of normal MRI findings in patients with NPSLE, providing further rationale to specifically assess MRI. Table 1 lists the different imaging modalities, their descriptions and common findings.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of structural magnetic resonance imaging findings between neuropsychiatric systemic lupus erythematosus and systemic lupus erythematosus patients: A systematic review and meta-analysis

Amin

Kaul

Smith

et al. 2017

Rheumatology Practice and Research

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Introduction: Neuropsychiatric systemic lupus erythematosus is often clinically challenging to diagnose, treat and monitor. Although brain magnetic resonance imaging is frequently performed before lumbar puncture in neuropsychiatric systemic lupus erythematosus, it is not clear from the literature whether specific brain magnetic resonance imaging findings are associated with distinct clinical features of neuropsychiatric systemic lupus erythematosus. Methods: We conducted a systematic review and meta-analysis on published studies of neuropsychiatric systemic lupus erythematosus including brain magnetic resonance imaging and the 1999 American College of Rheumatology-defined clinical neuropsychiatric systemic lupus erythematosus syndromes to determine their relationship. Pooled prevalence and risk ratio for distinct neuropsychiatric systemic lupus erythematosus associations were determined with 95% confidence intervals. Results: Of 821 studies screened, 21 fulfilled inclusion criteria. A total of 818 participants were evaluated (91% female) with 1064 neuropsychiatric systemic lupus erythematosus episodes assessed. Neuropsychiatric systemic lupus erythematosus features included headache (24%), seizures (19%), cerebrovascular disease (18%), cognitive dysfunction (15%) and acute confusional state (14%). Normal magnetic resonance imaging was significant for anxiety disorder (risk ratio: 9.00; 95% confidence interval: 2.40, 33.79), autonomic disorder (risk ratio: 7.00; 95% confidence interval: 0.51, 96.06) and plexopathy (risk ratio: 5.00; 95% confidence interval: 0.81, 31.00). Highest risk ratio of neuropsychiatric systemic lupus erythematosus syndrome with abnormal magnetic resonance imaging was observed for cerebrovascular disease (risk ratio: 0.15; 95% confidence interval: 0.10, 0.24) and demyelination (risk ratio: 0.11; 95% confidence interval: 0.02, 0.72). Conclusion: Normal magnetic resonance imaging in neuropsychiatric systemic lupus erythematosus was the most significant correlate from our meta-analysis for psychological symptoms including anxiety and peripheral nerve features of autonomic disorder and plexopathy. The main abnormal brain magnetic resonance imaging correlates included cerebrovascular disease and demyelination. Brain magnetic resonance imaging correlates poorly with neuropsychiatric systemic lupus erythematosus features, and specific clinical symptoms should be the main determinants of performing magnetic resonance imaging rather than presence of neuropsychiatric systemic lupus erythematosus per se.

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