Objective. The aim of this study was to determine whether there are differences in white matter integrity between systemic lupus erythematosus (SLE) patients and healthy controls, as determined... Show moreObjective. The aim of this study was to determine whether there are differences in white matter integrity between systemic lupus erythematosus (SLE) patients and healthy controls, as determined using tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging data. Methods. Twelve patients with SLE (mean age 42 years [range 15-61 years]) diagnosed according to the American College of Rheumatology 1982 revised criteria for SLE and 28 healthy controls (mean age 46 years [range 21-61 years]) were included in the study. Magnetic resonance imaging was performed on a 3.0T scanner. Fractional anisotropy (FA) maps were calculated for each patient. TBSS analysis was used to compare the FA maps. The TBSS technique projects the FA data into a common space through the use of an initial approximate nonlinear registration, followed by projection onto an alignment-invariant tract representation (mean FA skeleton). The cluster results were corrected for multiple comparisons across space, and a threshold of significance of 0.05 was used. Results. The white matter of tracts in the inferior fronto-occipital fasciculus, the fasciculus uncinatus, as well as the fornix, the posterior limb of the internal capsule (corticospinal tract), and the anterior limb of the internal capsule (anterior thalamic radiation) of patients with SLE showed reduced integrity as compared with normal subjects. Conclusion. In this preliminary study, the integrity of white matter tracts in areas around limbic structures and in the internal capsule was found to be reduced. Larger studies could improve our understanding of the pathologic mechanisms behind the reduced white matter tract integrity in SLE. Show less
OBJECTIVE:: The clinical manifestations of nervous system involvement in systemic lupus erythematosus (neuropsychiatric SLE or NPSLE) are highly diverse and their etiology is incompletely... Show moreOBJECTIVE:: The clinical manifestations of nervous system involvement in systemic lupus erythematosus (neuropsychiatric SLE or NPSLE) are highly diverse and their etiology is incompletely understood. The aim of this study was to provide an inventory of abnormalities on conventional brain MRI in NPSLE and to interpret the findings in relation to possible underlying pathogenetic mechanisms. METHODS:: MRI exams of the first episode of active NPSLE of 74 patients were retrospectively reviewed. All patients fulfilled the revised 1982 ACR criteria for SLE and were classified according to the 1999 ACR case definitions for NPSLE syndromes. Patients with a history of brain disease, and patients in whom other mechanisms unrelated to SLE caused the neuropsychiatric symptoms, were excluded. RESULTS:: The principal findings were: 1) focal hyperintensities in WM (49% of all patients) or both WM and GM (5%) suggestive of vasculopathy or vasculitis, 2) more widespread, confluent hyperintensities in the WM, suggestive of chronic hypoperfusion due to the same mechanisms, 3) diffuse cortical GM lesions (12%), compatible with an immune response to neuronal components or post-seizure changes, and 4) absence of MRI abnormalities, despite active signs and symptoms (42%). CONCLUSION:: Several distinct brain MRI patterns were observed in patients with active NPSLE, suggestive of different pathogenetic mechanisms. To advance our understanding of the various processes leading to NPSLE, the radiological manifestations may be a good starting point and useful for categorization of patients in further research. Show less
Purpose: To use perfusion weighted MR to quantify any perfusion abnormalities and to determine their contribution to neuropsychiatric (NP) involvement in systemic lupus erythematosus (SLE).... Show morePurpose: To use perfusion weighted MR to quantify any perfusion abnormalities and to determine their contribution to neuropsychiatric (NP) involvement in systemic lupus erythematosus (SLE). Materials and methods: We applied dynamic susceptibility contrast (DSC) perfusion MRI in 15 active NPSLE, 26 inactive NPSLE patients. and 11 control subjects. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were reconstructed and regions of interest were compared between groups. In addition, the effect of SLE criteria, NPSLE syndromes. immunological coagulation disorder, and medication on CBF. CBV, and MTT was investigated. Results: No significant differences were found between the groups in CBF, CBV, and MTT. No significant influence of SLE criteria or NPSLE syndromes on CBF, CBV, or MTT was found. No significant influence of anti-cardiolipin antibodies, lupus anti-coagulant, the presence of anti-phospholipid syndrome (APS), or medication on CBF, CBV. or MTT was found. Conclusion: Our findings suggest CBF. CBV, and MTT in the white and the gray matter in SLE patients is not significantly different from healthy controls or between patients with and without specific symptoms or with and without immunological disorder involving coagulation. Show less
