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MRI features of parenchymal neuro-Behçet's disease: a systematic review and meta-analysis
Hind Alnajashi1, Hussain Ali J Almohammed2, Ahmed Salah Morad3
1Department of Neurology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Introduction:
Magnetic resonance imaging (MRI) is essential for diagnosing neuro-Behçet's disease (NBD). The classic MRI sign typically results from parenchymal NBD lesions in the thalamus, midbrain, and the internal capsule. It may also affect the spinal cord, bilateral basal ganglia, pons, and white matter. Despite its importance, a comprehensive quantitative synthesis of MRI characteristics differentiating NBD subtypes is still needed. This study aimed to compare specific MRI findings, such as brainstem atrophy, enhancing lesions, and anatomical distribution, in acute and chronic progressive parenchymal NBD, with potential implications for prognosis and long-term disease management.
Methods:
This systematic review and meta-analysis was conducted according to the PRISMA 2020 guidelines. PubMed, Web of Science, and Scopus were searched from inception to August 2025. Retrospective studies assessing the MRI findings of parenchymal NBD were included.
Results:
Seven retrospective studies (total n = 327) with parenchymal NBD met the inclusion criteria. The characteristic lesions showed that brainstem atrophy was significantly less in the acute NBD group than in the chronic progressive NBD group (OR = 0.03, 95% CI [0.01, 0.11], p < 0.00001). Contrast-enhancing lesions were significantly more frequent in acute parenchymal NBD, consistent with active inflammatory disease (OR = 2.58, 95% CI [1.04, 6.40], p = 0.04). However, the anatomical distribution of MRI lesions does not differ significantly between acute and chronic progressive NBD. No significant difference was observed between the mild-to-moderate and severe groups in the brainstem (OR = 0.42, p = 0.22) and thalamus (OR = 0.31, p = 0.12).
Conclusion:
Our analysis provides quantitative evidence for distinct MRI characteristics, such as differential brainstem atrophy and enhanced lesion incidence, which may inform NBD subtyping and have implications for prognosis and long-term disease management. However, this meta-analysis is limited by the retrospective nature of the included studies and their potential heterogeneity, necessitating further prospective research to confirm these findings.
Systematic Review Registration:
PROSPERO, CRD420251178483.
