Brain MRI in neuropsychiatric lupus: associations with the 1999 ACR case definitions

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.

Magnetic resonance imaging (MRI) brain abnormalities of neuropsychiatric systemic lupus erythematosus patients in Mansoura city: Relation to disease activity

“…Many studies discussed the role of MR imaging in the assessment of focal lesions of the brain in patients with NPSLE [16][17][18][19][20].…”

Comparison of structural magnetic resonance imaging findings between neuropsychiatric systemic lupus erythematosus and systemic lupus erythematosus patients: A systematic review and meta-analysis

“…41 The duration from NPSLE diagnosis to MRI was not specified in 16 papers. In three papers, the duration from NPSLE diagnosis to MRI was less than 3 months, 31,32,33 it was up to 1 year in one study, 35 while it was a mean 47.1 months in another study. 46 Disease activity was defined and reported in eight studies.…”

“…In 10 papers, T1, T2 and fluid-attenuated inversion recovery (FLAIR) were used; 20 25 and MRI, SPECT. 42 Five studies were undertaken in the United States, 21,36,41,44,45 three in Japan, 34,35,46 two in South Korea, 25,32 two from the Netherlands 20,24 and two from Brazil. 38,39 Single studies were undertaken in Turkey, 37 China, 27 Poland, 40 Canada, 42 Germany 43 and Spain, 33 while one study was conducted in both Spain and the United Kingdom.…”

Neuropsychiatric Lupus in clinical practice

“…Nonetheless, a recent meta-analysis did not confirm this finding 11 . Headache in SLE is not associated with a higher frequency of magnetic resonance imaging (MRI) lesions, disease activity, and biomarkers such as aPL, anti-P, and glutamate receptor antibodies (anti-NR2) 12,13 . Focal neurological signs, fever or concomitant infection, presence of antiphospholipid syndrome (APS), immunosuppression, use of anticoagulants, altered mental status, meningismus and generalized SLE activity are indicative of secondary causes of headache and require further investigation with brain imaging and cerebrospinal (CSF) analysis 8,14 .…”

“…Abnormalities on the EEG are common (60% to 70%) in SLE, and epileptiform EEG patterns suggest the seizure is likely to recur (73% positive predictive value, 79% negative predictive value) 24 . Patients with seizures show more gray matter hyperintensities on MRI images and may develop brain atrophy 13 . Inflammatory processes are believed to play a major role in the pathogenesis of epileptic seizures 25 .…”