Perfusion MRI in neuro‐psychiatric systemic lupus erthemathosus

Emmer, Bart J.; Osch, Matthias J.P. van; Wu, Ona; Steup-Beekman, Gerda M; Steens, Stefan C. A.; Huizinga, Tom W J; Buchem, Mark A. van; Grond, Jeroen van der

doi:10.1002/jmri.22251

Cited by 25 publications

(30 citation statements)

References 21 publications

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“…[16][17][18] These studies were performed using different MR scanners and were conducted on different subject groups including SLE patients with depression and visible brain lesions, which may explain the discrepancy between their and our results. Our results are in accordance with the study by Emmer et al 15 performed with a 1.5 Tesla scanner. Similarly to that study we also did not find any significant hypoperfusion, within either gray or white matter of patients with NPSLE and SLE, though we noticed a tendency to lower values of rCBV in several cortical regions in both patient subgroups.…”

Section: Discussionsupporting

confidence: 96%

In vivo evaluation of brain damage in the course of systemic lupus erythematosus using magnetic resonance spectroscopy, perfusion-weighted and diffusion-tensor imaging

Zimny¹,

Szmyrka²,

Szewczyk³

et al. 2013

Lupus

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Twenty-two neuropsychiatric (NPSLE) and 13 systemic lupus erythematosus (SLE) patients with a normal appearing brain on plain magnetic resonance (MR) as well as 20 age-matched healthy controls underwent MR spectroscopy (MRS), perfusion-weighted (PWI) and diffusion-tensor imaging (DTI). In MRS NAA/Cr, Cho/Cr and mI/Cr ratios were calculated from the posterior cingulate cortex and left parietal white matter. In PWI, values of cerebral blood volume (CBV) were assessed from 14 regions, including gray and white matter. In DTI fractional anisotropy (FA) values were obtained from 14 white matter tracts including projection, commissural and association fibers. All MR measurements were correlated with clinical data. SLE and NPSLE patients showed significantly (p < 0.05) lower NAA/Cr ratios within both evaluated regions and FA values within the cingulum, as well as a tendency to cortical hypoperfusion. Compared to SLE, NPSLE subjects revealed lower FA values within a wide range of association fibers and corpus callosum. Advanced MR techniques are capable of in vivo detection of complex microstructural brain damage in SLE and NPSLE subjects regarding neuronal loss, mild hypoperfusion and white matter disintegrity. MRS and DTI seem to show the highest usefulness in depicting early changes in normal appearing gray and white matter in SLE patients.

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Section: Discussionsupporting

confidence: 96%

In vivo evaluation of brain damage in the course of systemic lupus erythematosus using magnetic resonance spectroscopy, perfusion-weighted and diffusion-tensor imaging

Zimny¹,

Szmyrka²,

Szewczyk³

et al. 2013

Lupus

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“…Our findings are in agreement with a similar study by Emmer et. al., which looked at larger areas of subcortical grey matter and central white matter and thalamus using larger ROI’s than in the present study and also did not find any statistically significant MR perfusion abnormalities in NPSLE patients compared to SLE and HC patients 9 .…”

Section: Discussioncontrasting

confidence: 58%

“…This significantly increased variability in CBF and CBV seen in NPSLE patients might partially explain why no significant changes in perfusion measures in NPSLE patients have been seen in previous studies and why researchers are struggling to find a specific diagnostic target for NPSLE 9,15,16 . Perhaps multiple concordant targets are necessary, or alternatively the diagnosis of NPSLE is too broad, and if narrowed, might render a clearer diagnostic tool.…”

Section: Discussionmentioning

confidence: 86%

“…Although several studies have described abnormal imaging findings and cortical atrophy in NPSLE patients, few studies have looked at dynamic perfusion in lupus patients. In contrast to the previously published studies, we wanted to see if lupus patients had focal areas of perfusion derangement and decided to use frontal white matter as a denominator/constant for our perfusion calculations 7,9 …”

Section: Introductionmentioning

confidence: 99%

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Perfusion-weighted MR Imaging in Cerebral Lupus Erythematosus

Wang¹,

Cagnoli²,

McCune³

et al. 2012

Academic Radiology

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Rationale and Objective NPSLE is a diagnostically challenging, severe, and life-threatening condition, which is currently lacking a “gold standard.” Our aim with this study is to look for MR perfusion differences in NPSLE, SLE, and HC patients and correlate our findings with clinical parameters. Materials and methods 24 NPSLE patients, 21 SLE patients, and 21 HC underwent dynamic susceptibility contrast enhanced MR perfusion using a 3 T scanner. Nine prospectively selected intracranial ROI were placed in white and grey matter and the CBF, CBV, and MTT values were calculated. Subjects underwent clinical evaluation with SLEDAI and serum antibodies. Results The SLE patients had higher CBF and CBV compared to the HC overall (p=0.01) and in specific areas (p=0.03–0.048). SLE patients with signs of active disease (elevated SLEDAI and anti-dsDNA) had significantly elevated CBV, CBF, and MTT in the posterior cingulate gyrus (p=0.01–0.02). No significant difference was seen in the MR perfusion measurements of NPSLE patients compared to SLE and HC, although the NPSLE patients also showed higher CBV variability compared to the SLE (p= 0.0004) and HC cohort (p<0.0001). Conclusion SLE patients have increased CBV and CBF compared to healthy controls. The SLE patients with clinical markers for active disease have elevated CBV, CBF, and MTT in the posterior cingulate gyrus. NPSLE patients show increased variability in perfusion measurements, which may explain why susceptibility contrast enhanced MRI has not yet provided a specific target for NPSLE.

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“…They have also demonstrated that the relative reduction in NAA in SLE patients might be transient, and it is probably dependent on disease activity, as NAA will increase after treatment and will change in patients going from having active to inactive disease (15,36). The role that disease activity might have on cerebral metabolic activity is supported by previous studies that have demonstrated changes in cerebral vascularity in SLE patients with active disease with elevated cerebral blood flow, cerebral blood volume, and mean transit time compared to HC subjects (37–39). Interestingly, despite a correlation between SLEDAI and the NAA at baseline, there were no correlation between the SLEDAI score improvement and the increase in NAA/Cr over time.…”

Section: Discussionmentioning

confidence: 71%

Reduced Insular Glutamine and N-Acetylaspartate in Systemic Lupus Erythematosus

et al. 2013

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Rationale and Objectives To investigate for differences in metabolic concentrations and ratios between patients with systemic lupus erythematosus (SLE) without (group SLE) and those with neurological symptoms (group NPSLE) compared to a healthy control (group HC) in three normal-appearing brain regions: the frontal white matter, right insula (RI), and occipital gray matter and whether changes in any of the metabolites or metabolic ratios are correlated to disease activity and other clinical parameters. Materials and Methods Twenty patients with SLE (18 women and 2 men, age range 23.4–64.6 years, mean age 43.9 years), 23 NPSLE patients (23 women, age range 23.7–69.8 years, mean age 42.4 years), and 21 HC (19 women and 2 men, age range 21.0–65.7 years, mean age 43.4 years) were included. All subjects had conventional brain magnetic resonance imaging and 1H single-voxel spectroscopy, clinical assessment, and laboratory testing. Results NPSLE patients had significantly reduced N-acetylaspartate (NAA)/creatine compared to HC (P = .02) and SLE patients (P = .01) in the RI. Lower glutamine/creatine levels were also detected in RI in both patient groups and in frontal white matter in NPSLE patients compared to HC (P = .01, P = .02). NAA/Cr ratio in the RI was significantly negatively correlated with the Systemic Lupus Erythematosus Disease Activity Index (r = −0.41; P = .008), and patients with active SLE symptoms also had a trend toward lower NAA/creatine ratios (1.02 vs 1.12; P = .07). Conclusions The present data support previous findings of abnormal metabolic changes in normal-appearing regions in the brain of both SLE and NPSLE patients and raise the possibility that especially NAA, glutamine, and glutamate may be additional biomarkers for cerebral disease activity in SLE patients as these early metabolic changes occur in the brain of SLE patients before neurologic and imaging manifestations become apparent.

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Perfusion MRI in neuro‐psychiatric systemic lupus erthemathosus

Cited by 25 publications

References 21 publications

In vivo evaluation of brain damage in the course of systemic lupus erythematosus using magnetic resonance spectroscopy, perfusion-weighted and diffusion-tensor imaging

In vivo evaluation of brain damage in the course of systemic lupus erythematosus using magnetic resonance spectroscopy, perfusion-weighted and diffusion-tensor imaging

Perfusion-weighted MR Imaging in Cerebral Lupus Erythematosus

Reduced Insular Glutamine and N-Acetylaspartate in Systemic Lupus Erythematosus

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