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Combined Brain/Heart Magnetic Resonance Imaging in Systemic Lupus Erythematosus

Sophie Mavrogeni1, Loukia Koutsogeorgopoulou2, Theodoros Dimitroulas3

  • 1Onassis Cardiac Surgery Center, Athens, Greece.

Current Cardiology Reviews
|August 2, 2019
PubMed

Insights

Combined brain and heart MRI may aid in assessing cardiovascular disease (CVD) and neuropsychiatric lupus erythematosus (NPSLE) risk. This approach could benefit high-risk SLE patients, particularly those with antiphospholipid syndrome, for early detection and management.

Area of Science:

  • Rheumatology
  • Cardiology
  • Neurology
  • Radiology

Background:

  • Cardiovascular Disease (CVD) and Neuropsychiatric SLE (NPSLE) affect 50% and 40% of SLE patients, respectively, and are leading causes of mortality.
  • Pathophysiology of NPSLE involves microangiopathy, infarcts, and atherosclerosis; brain MRI detects lesions in 50% of cases, with advanced techniques identifying pre-clinical changes.
  • Cardiac involvement in SLE includes myo-pericarditis, valvular disease, heart failure, coronary disease, vasculitis, and pulmonary hypertension, detectable by classic and advanced Cardiac MRI (CMR) indices.

Purpose of the Study:

  • To propose a combined brain/heart Magnetic Resonance Imaging (MRI) approach for risk stratification in Systemic Lupus Erythematosus (SLE).
  • To explore the potential utility of advanced MRI techniques for early detection of pre-clinical cardiovascular and neurological damage in SLE patients.

Main Methods:

  • Review of current literature on cardiovascular and neuropsychiatric manifestations of SLE.
  • Discussion of the role of classic and advanced brain MRI and Cardiac MRI (CMR) in diagnosing and monitoring SLE-related complications.
  • Exploration of the potential application of combined brain/heart MRI for risk stratification in specific SLE patient subgroups.

Main Results:

  • Classic brain MRI shows lesions in 50% of NPSLE cases; advanced MRI can detect pre-clinical lesions in most NPSLE patients.
  • Classic and advanced CMR indices enable functional and tissue characterization for early diagnosis and follow-up of CVD in SLE.
  • While no clinical data currently support combined MRI in asymptomatic SLE, it shows promise for high-risk patients.

Conclusions:

  • Combined brain/heart MRI may be valuable for SLE risk stratification, particularly in patients with clinical suspicion of brain/heart involvement or those at high risk for CVD/stroke, such as SLE/APS.
  • This approach could also benefit SLE patients with multi-organ involvement, concurrent cardiac and neurological issues, or recent onset of arrhythmia/heart failure.
  • Further clinical data are needed to establish the definitive role of combined brain/heart MRI in SLE management.

Keywords:
Magnetic resonance imagingbrain lesionscardiovascular diseasecognitive dysfunctionneuropsychiatric symptomssystemic lupus erythematosus

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