Multimodal imaging in systemic lupus erythematosus patients with diffuse neuropsychiatric involvement

Area of Science:

• Neurology
• Radiology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) is an autoimmune disease with potential central nervous system (CNS) involvement.
• Diffuse neuropsychiatric SLE (dNPSLE) presents a significant clinical challenge, necessitating advanced diagnostic tools.
• Understanding the neuroimaging correlates of dNPSLE is crucial for diagnosis and management.

Purpose of the Study:

• To compare conventional and advanced brain MRI findings in dNPSLE patients versus healthy controls (HCs).
• To identify specific MRI markers associated with diffuse CNS involvement in SLE.

Main Methods:

• A multimodal 3T MRI approach was employed.
• Twenty-six dNPSLE patients and 36 HCs underwent brain scanning.
• Univariate and multivariate analyses assessed lesion burden, atrophy, MTR, and DTI parameters.

Main Results:

• dNPSLE patients showed increased T1 lesion number and volume compared to HCs.
• Significant whole brain, gray matter, and cortical volume reductions were observed in dNPSLE.
• Increased axial diffusivity in normal-appearing white matter (NAWM) indicated axonal injury in dNPSLE patients.

Conclusions:

• Cortical and central brain atrophy are key MRI findings in SLE patients with diffuse CNS syndromes.
• Diffusion tensor imaging (DTI) measures, specifically increased axial diffusivity (AD) in NAWM, suggest predominant axonal density reduction in dNPSLE.
• These neuroimaging findings highlight microscopic tissue injury in the normal-appearing white matter of SLE patients.