Perfusion-weighted MR Imaging in Cerebral Lupus Erythematosus

Abstract

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.

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

“…To our knowledge there are only a few studies on perfusion changes measured with MR in patients with SLE and they gave contradictory results ranging from hypo-to hyperperfusion. [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.…”

Reduced Insular Glutamine and N-Acetylaspartate in Systemic Lupus Erythematosus

“…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.…”

Neuropsychiatric lupus or not? Cerebral hypoperfusion by perfusion-weighted MRI in normal-appearing white matter in primary neuropsychiatric lupus erythematosus

“…Lesion burden of small (<1 cm) white matter hyperintensities on T2/FLAIR sequences was classified according to their absolute number: grade 0=none, grade 1 (mild)=1–5, grade 2 (moderate)=6–10 or grade 4 (severe) >10 24. The T2* DSC-MRI was performed with 2D single-shot multislice Gradient Echo Planar Imaging sequence (time repetition (TR)/time echo (TE)/flip angle (FA): 1500 ms/40 ms/30 o , band width (BW): 2442 Hz/pixel, echo spacing: 0.47 ms, echo planar imaging factor 64).…”