White matter abnormalities in an MRI-based study in Behçet's syndrome: incidental findings or clinically relevant?

This study aimed to assess prevalence, distribution, severity and clinical correlates of white matter abnormalities (WMAs) at brain magnetic resonance imaging (bMRI) in Behçet's syndrome patients without active Neuro-Behçet's syndrome (NBS).

We retrospectively analysed the bMRI scans of a real-world BS cohort without active neurological involvement. The WMAs in the deep and periventricular white matter were assessed using the Fazekas scale, and WMAs were mapped across predefined cerebral regions. Associations with demographic and clinical data, disease activity (Behçet's disease current activity form [BDCAF]), history of chronic headache and active headache at scan time were analysed.

Ninety-five patients (F 72%, M 28%) were evaluated. Periventricular WMAs were nearly absent, while DWM-Fazekas scores ranged from 0 to 1. Lesions predominantly involved the sub-cortical region. No significant differences in the severity and distribution of WMAs were observed according to gender or headache history/status. A positive correlation between Fazekas scores and age was observed, whereas deep WMAs negatively correlated with BDCAF.

In BS patients without overt neurological involvement, WMAs are infrequent, mild and predominantly age-related rather than disease-related. These findings suggest that incidental WMAs should not automatically be attributed to subclinical NBS. Advanced imaging and controlled studies are needed to further clarify their clinical significance.