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Brain MRI in neuropsychiatric lupus: associations with the 1999 ACR case definitions
Hae Woong Jeong1, Minyoung Her, Jong Seok Bae
1Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, Busan, South Korea.
Abstract:
The purpose of this study was to identify the characteristic magnetic resonance imaging (MRI) findings in neuropsychiatric systemic lupus erythematosus (NPSLE) and to investigate the association between MRI findings and neuropsychiatric manifestations in SLE. Brain MRIs with a diagnosis of SLE from 2002 to 2013 from three tertiary university hospitals were screened. All clinical manifestations evaluated by brain MRI were retrospectively reviewed. If the clinical manifestations were compatible with the 1999 NPSLE American College of Rheumatology (ACR) nomenclature and case definitions, the brain MRIs were assessed for the presence of white matter hyperintensities, gray matter hyperintensities, parenchymal defects, atrophy, enhancement, and abnormalities in diffusion-weighted images (DWI). The number, size, and location of each lesion were evaluated. The neuropsychiatric manifestation of each brain MRI was classified according to the 1999 ACR NPSLE case definitions. The associations between MRI findings and NPSLE manifestations were examined. In total, 219 brain MRIs with a diagnosis of SLE were screened, and 133 brain MRIs met the inclusion criteria for NPSLE. The most common MRI abnormality was white matter hyperintensities, which were observed in 76 MRIs (57.1 %). Gray matter hyperintensities were observed in 41 MRIs (30.8 %). Parenchymal defects were found in 31 MRIs (23.3 %), and atrophy was detected in 20 MRIs (15.0 %). Patients who had seizures were more associated with gray matter hyperintensities than patients with other neuropsychiatric manifestations. Patients with cerebrovascular disease were more associated with gray matter hyperintensity, parenchymal defects, and abnormal DWI than patients with other neuropsychiatric manifestations. In addition to white matter hyperintensities, which were previously known as SLE findings, we also noted the presence of gray matter hyperintensities, parenchymal defects, and abnormal DWI in a substantial portion of SLE patients, particularly in those with cerebrovascular disease or seizures.
Insights
Neuropsychiatric lupus erythematosus (NPSLE) brain MRI shows white matter hyperintensities, gray matter hyperintensities, and parenchymal defects. These findings correlate with seizures and cerebrovascular disease in NPSLE patients.
Area of Science:
- Neurology
- Radiology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) can affect the central nervous system, leading to neuropsychiatric lupus erythematosus (NPSLE).
- Characteristic neuroimaging findings in NPSLE are crucial for diagnosis and understanding disease mechanisms.
Purpose of the Study:
- To identify characteristic magnetic resonance imaging (MRI) findings in NPSLE.
- To investigate the association between specific MRI findings and neuropsychiatric manifestations in SLE patients.
Main Methods:
- Retrospective review of brain MRIs from SLE patients diagnosed between 2002 and 2013.
- Assessment of MRI findings including white matter hyperintensities, gray matter hyperintensities, parenchymal defects, atrophy, enhancement, and diffusion-weighted imaging (DWI) abnormalities.
- Classification of neuropsychiatric manifestations according to 1999 American College of Rheumatology (ACR) NPSLE criteria and examination of associations with MRI findings.
Main Results:
- 133 of 219 screened SLE brain MRIs met NPSLE criteria.
- White matter hyperintensities were most common (57.1%), followed by gray matter hyperintensities (30.8%), parenchymal defects (23.3%), and atrophy (15.0%).
- Gray matter hyperintensities were associated with seizures; gray matter hyperintensity, parenchymal defects, and abnormal DWI were associated with cerebrovascular disease.
Conclusions:
- Beyond white matter hyperintensities, gray matter hyperintensities, parenchymal defects, and abnormal DWI are significant MRI findings in NPSLE.
- These findings are particularly relevant in SLE patients experiencing seizures or cerebrovascular disease.
- MRI plays a vital role in characterizing NPSLE and its neurological complications.
