Altered white matter microstructure in lupus patients: a diffusion tensor imaging study

Abstract

BackgroundThe purpose of this study was to investigate whether white matter microstructure is altered in patients suffering from systemic lupus erythematosus (SLE), and if so, whether such alterations differed between patients with and without neuropsychiatric symptoms.MethodsStructural MRI and diffusion tensor imaging (DTI) were performed in 64 female SLE patients (mean age 36.9 years, range 18.2–52.2 years) and 21 healthy controls (mean age 36.7 years, range 23.3–51.2 years) in conjunction with clinical examination, laboratory tests, cognitive evaluation, and self-assessment questionnaires. The patients were subgrouped according to the American College of Rheumatology Neuropsychiatric Systemic Lupus Erythematosus case definitions into non-neuropsychiatric SLE (nonNPSLE) and neuropsychiatric SLE (NPSLE).ResultsComparisons between the SLE group and healthy controls showed that the mean fractional anisotropy (FA) was significantly reduced in the right rostral cingulum (p = 0.038), the mid-sagittal corpus callosum (CC) (p = 0.050), and the forceps minor of the CC (p = 0.015). The mean diffusivity (MD) was significantly increased in the left hippocampal cingulum (p = 0.017). No significant differences in MD or FA values were identified between NPSLE and nonNPSLE patients. Disease duration among all SLE patients correlated significantly with reduced FA in the CC (p < 0.05). No correlations were found between DTI parameters and white matter hyperintensities, SLE Disease Activity Index-2000, Systemic Lupus International Collaborating Clinical/ACR Organ Damage Index, or Montgomery Asberg Depression Rate Score Self-report.ConclusionsWe found alterations of white matter microstructure in SLE patients that were related to disease duration and fatigue. Our results indicate that cerebral involvement in SLE is not isolated to the NPSLE subgroup.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1516-0) contains supplementary material, which is available to authorized users.

Metabolic and microstructural alterations in the SLE brain correlate with cognitive impairment

“…Additional longitudinal studies are needed to verify this prediction. While several studies have reported WM alterations in NPSLE compared with HC subjects in segments of the CC, the forceps, anterior corona radiata, thalamus, and parietal and frontal lobes (33-36) and overall diminished volume of the CC (34, 37), our results support the growing body of literature demonstrating significant WM abnormalities in SLE subjects without acute neuropsychiatric manifestations (38)(39)(40)(41)(42). Most of these studies in SLE subjects without neuropsychiatric manifestations failed to demonstrate significant correlations between diminished WM integrity and cognition.…”

Functional connectivity changes in core resting state networks are associated with cognitive performance in systemic lupus erythematosus

“…In a previous study on diffusion tensor imaging in SLE‐patients, we concluded that the white matter microstructure in SLE patients was altered in areas crucial for attention, mood, and cognitive functions. Importantly, this was also the case in patients without NP‐involvement (Nystedt, Nilsson, et al, ).…”

From Systemic Inflammation to Neuroinflammation: The Case of Neurolupus

“…Today, several advanced imaging modalities exist. These include diffusion-weighted imaging (DWI) [ 105 ], magnetic transfer imaging (MTI) [ 106 ], magnetic resonance angiography (MRA) [ 107 ], magnetic resonance spectroscopy (MRS) [ 108 ], diffusion tensor imaging (DTI) [ 109 ], and blood oxygen level-dependent functional MRI (BOLD-fMRI) [ 93 ], and they ideally could be implemented for identifying functional hallmarks of NPSLE and allow its diagnosis [ 11 , 110 ]. These methods are not detailed here, as this review rather focuses on data obtained in preclinical research performed on murine NPSLE models.…”