The contribution of fast-FLAIR MRI for lesion detection in the brain of patients with systemic autoimmune diseases

Abstract

Fast fluid-attenuated inversion recovery (fFLAIR) is more sensitive that conventional or fast spin echo T2-weighted magnetic resonance imaging (MRI) for detecting lesions in the brain of patients with ischemic, inflammatory, or demyelinating diseases of the CNS. We investigated whether the use of fFLAIR also increases the sensitivity of brain MRI assessment in patients with systemic autoimmune disorders. Turbo spin echo (TSE) dual-echo and fFLAIR scans of the brain were obtained from patients affected by systemic lupus erythematosus (SLE) with (NSLE, n = 9) and without clinical CNS involvement (n = 15), Behçet disease (n = 5), Wegener granulomatosis (n = 9), and antiphospholipid antibody syndrome (n = 6). Brain hyperintense lesions were counted and classified according to their size and their location by two observers by consensual agreement. The total lesion volume was measured using a semiautomated technique for lesion segmentation on both TSE and fFLAIR scans. The imaging modalities showed brain hyperintense lesions in all 9 SLE patients with CNS involvement, 5 of 15 SLE patients without CNS involvement, 5 of 9 patients with Wegener granulomatosis, 1 of 5 with Behçet disease, and 3 of 6 with antiphospholipid antibody syndrome. A total of 342 lesions were seen on both sequences; 88 were seen only on TSE and 54 only on fFLAIR scans. The average number of brain lesions per scan was higher on TSE than on fFLAIR, since significantly more discrete (P<0.002) and small (P = 0.004) lesions were seen on TSE than on fFLAIR. The median total lesion volume, however, was similar on TSE and fFLAIR. Our study indicates that the use of fFLAIR does not improve the sensitivity of fast dual-echo MRI for detecting brain abnormalities in patients with systemic autoimmune disorders.

Differentiation of Multiple Sclerosis from Other Inflammatory Disorders and Cerebrovascular Disease: Value of Spinal MR Imaging

“…Little is known about the frequency of spinal cord abnormalities in inflammatory disorders and cerebrovascular disease. In one recent study (34), no focal cervical cord lesions were reported on MR images obtained in 44 patients with inflammatory disorders, even though 30% of the images showed brain abnormalities that mimicked MS (35). No comparison was made with patients with cerebrovascular disease, however, and the occurrence of diffuse spinal cord abnormalities was not analyzed.…”

Brain Magnetic Resonance Imaging in Newly Diagnosed Systemic Lupus Erythematosus

“…Multiple discrete white-matter lesions in the periventricular, cortical/subcortical junction, and frontal lobe regions are more common in patients with past NPSLE manifestations than in SLE patients without a history of NPSLE 1 . Multiple small periventricular and subcortical white-matter lesions seen by MRI also contribute to severe impairment in tests of strategic cognitive flexibility in patients with current and past NPSLE 5 .…”

“…Research using structural MRI in SLE patients with longstanding disease has found that small focal lesions concentrated in the periventricular and subcortical white matter are common in patients with NPSLE 1–4 . Multiple discrete white-matter lesions in the periventricular, cortical/subcortical junction, and frontal lobe regions are more common in patients with past NPSLE manifestations than in SLE patients without a history of NPSLE 1 .…”

Magnetic Resonance Imaging in Neuropsychiatric Lupus

“…The differential diagnosis of WMH is very wide, being associated with many conditions including ageing, dyslipidemia, diabetes, hypertension, heart diseases and migraine 27 . However, many previous reports already proved increased frequency of WMH in SLE and NPSLE 21, 29– 36 . WMH had been shown to involve preferentially the frontal and parietal lobes, consistent with an anterior to posterior gradient, similar to other causes of WMH, but different from inflammatory demyelinating etiologies such as multiple sclerosis 8, 37 .…”