Detection of cerebral involvement in patients with active neuropsychiatric systemic lupus erythematosus by the use of volumetric magnetization transfer imaging

Bosma, G. P. Th.; Rood, M. J.; Huizinga, Tom W J; Jong, Brigit A. de; Bollen, E.; Buchem, Mark A. van

doi:10.1002/1529-0131(200011)43:11<2428::aid-anr9>3.0.co;2-h

Cited by 59 publications

(39 citation statements)

References 37 publications

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“…In these studies, NPSLE patients without visible abnormalities on conventional MR sequences had a lower MTR peak height compared to healthy controls and SLE patients without neuropsychiatric symptoms (12,16,17). Furthermore, these cross-sectional studies found correlations between MTR peak height and psychiatric, neurologic, and cognitive function, which suggests that the MTR peak height is clinically relevant (17).…”

Section: Dicussionmentioning

confidence: 78%

“…MTR histograms, normalized for tissue volume, were generated for the whole brain and for normal-appearing brain tissue. From these MTR histograms the peak height was calculated (12,16,17). The peak height of these histograms was used as a measure of cerebral lesion load (17).…”

Section: Image Processingmentioning

confidence: 99%

“…MTI was recently applied to NPSLE patients in several studies with a cross-sectional design (12,16). In these studies, NPSLE patients without visible abnormalities on conventional MR sequences had a lower MTR peak height compared to healthy controls and SLE patients without neuropsychiatric symptoms (12,16,17).…”

Section: Dicussionmentioning

confidence: 99%

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Detection of change in CNS involvement in neuropsychiatric SLE: A magnetization transfer study

Emmer

Steens

Steup-Beekman

et al. 2006

Magnetic Resonance Imaging

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Purpose: To assess whether magnetization transfer imaging (MTI) parameters change in correspondence with clinical changes in NPSLE patients. Materials and Methods:Nineteen female patients (mean age ϭ 37.5 years, range ϭ 19 -64) underwent MTI on at least two separate occasions (mean time between scans ϭ 25.4 months, range ϭ 5.4 -52.3 months). Twenty-four pairs of scans of 19 patients were available. Each patient's clinical course was classified as improved, stable, or deteriorated. Whole-brain magnetization transfer ratio (MTR) histograms were generated. The peak height of these histograms was used as an estimate of parenchymal integrity. Based on the change in clinical status, paired examinations were grouped and tested for significant differences between the first and second examinations using paired-samples t-tests. Results:Four patients clinically deteriorated, all patients showed a significant peak height decrease (mean decrease ϭ 8.6%, P ϭ 0.02), and in 14 patients with stable disease the peak height did not change significantly (mean increase ϭ 0.4%). Six patients clinically improved, and all showed a significant relative peak height increase (mean increase ϭ 12.0%, P ϭ 0.02). Conclusion:The peak height of whole-brain MTR histograms corresponds to changes in the clinical status of individual NPSLE patients. This suggests that MTI can be a valuable tool in the clinical assessment of such patients.

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Section: Dicussionmentioning

confidence: 78%

Section: Image Processingmentioning

confidence: 99%

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Detection of change in CNS involvement in neuropsychiatric SLE: A magnetization transfer study

Emmer

Steens

Steup-Beekman

et al. 2006

Magnetic Resonance Imaging

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“…Bosma et al (2000a, b) have applied MTI to the characterization of normal appearing brain tissue and the evolution of lesions in SLE. In one of their studies (Bosma et al 2000a), they used MTI to study MS and SLE patients with and without a history of NP involvement. Magnetization transfer ratio histograms were abnormal in NP-SLE and MS patients, and the authors suggested that these manifestations in the cerebral white matter could include focal areas of demyelination, and/or vasculopathy.…”

Section: Brain Imaging Findings In Slementioning

confidence: 99%

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

et al. 2008

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In this manuscript, we review literature describing the neuropsychological and brain imaging characteristics of systemic lupus erythematosus (SLE) patients. The findings are compared and contrasted with multiple sclerosis (MS) studies, revealing similarities and differences of interest to clinicians and researchers. While cognitive impairment is somewhat less common in SLE than MS, the diseases share a similar cognitive profile with deficits most prominent on tests emphasizing the speed of information processing, working memory, and visual/spatial learning, and memory. In early or more mildly affected patients, diffuse white matter damage, which may not be apparent on conventional brain imaging, plays a major role in clinical presentation and cognitive testing. The causes of white matter damage are very different, however, and in later stages of the disease MS and SLE appear to give rise to different forms of cerebral pathology. MS may be characterized by increasing brain atrophy affecting especially the cortical and deep gray matter, at least after conversion to secondary progressive course. There is less evidence for neurodegenerative changes in SLE, but patients are increasingly at risk for cerebrovascular disease. We conclude by offering some suggestions for future clinical and imaging research. KeywordsSystemic lupus erythematosus; Multiple sclerosis; Cognition; Memory; Processing speed; MRI; Effect size Systemic lupus erythematosus (SLE) is a relapsing-remitting autoimmune disease with wide ranging organ involvement and clinical symptoms varying from mild and transient symptoms to death. Cognitive impairment is reported in SLE, even among those patients without documented or overt signs of central nervous system (CNS) involvement. Presumably, cognitive disorder is the result of underlying brain disease although the precise mechanisms remain to be elucidated. The prevalence and degree of cognitive impairment is also uncertain.In this article we will endeavor to evaluate the evidence for neuropsychological impairment in SLE, and to compare the findings with that of MS, another immunological disorder whose symptoms wax and wane and which affects women more than men. Unlike SLE, MS is a disease that always impacts the CNS, and the causes of cognitive disorder in MS are better understood.

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“…Using MTI, a quantitative MRI technique that is sensitive to both macroscopic and microscopic CNS damage (4), abnormalities that had been invisible by conventional MRI were demonstrated in the brain parenchyma of NPSLE patients (5). Significant associations with parameters of neurologic, psychiatric, and neuropsychological function demonstrated the clinical relevance of these findings (6).…”

mentioning

confidence: 99%

Selective gray matter damage in neuropsychiatric lupus

Steens¹,

Admiraal-Behloul²,

Bosma³

et al. 2004

Arthritis & Rheumatism

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Objective. Damage of brain parenchyma in patients with primary diffuse neuropsychiatric systemic lupus erythematosus (NPSLE) has been indicated by magnetization transfer imaging (MTI). However, the location of MTI abnormalities is unknown. This study was undertaken to assess the distribution of MTI abnormalities over gray matter (GM) and white matter (WM) in SLE patients with a history of NP symptoms without explanatory magnetic resonance imaging (MRI) evidence of focal disease.Methods. MTI was performed in 24 female SLE patients with a history of diffuse NP symptoms and 24 healthy female controls. Magnetization transfer ratio (MTR) maps were calculated for GM and WM separately, and GM and WM MTR histograms were generated. Univariate and multivariate analyses with age as an additional covariate were performed on the histogram parameters peak location (PL), peak height (PH), and mean MTR.Results. Compared with controls, significantly reduced PH (mean ؎ SD 136 ؎ 22 arbitrary units versus 151 ؎ 13 arbitrary units) and mean MTR (33.3 ؎ 1.0 percent units versus 33.6 ؎ 0.5 percent units) were found in the GM of NPSLE patients (P ‫؍‬ 0.002 and P ‫؍‬ 0.033, respectively, in multivariate analyses). No significant differences were observed for WM MTR parameters.Conclusion. This is the first study to demonstrate, using MTI, that in SLE patients with a history of NP symptoms and without explanatory focal abnormalities on MRI, the GM is particularly affected. These findings support the hypothesis that neuronal injury may underlie central nervous system manifestations in NPSLE.Up to 75% of patients with systemic lupus erythematosus (SLE) experience neuropsychiatric symptoms indicative of central nervous system (CNS) involvement. In primary neuropsychiatric SLE (NPSLE), these NP manifestations are attributed to the SLE disease process itself, rather than to secondary factors such as infections or metabolic disorders (1). Focal neurologic NP syndromes are often associated with antiphospholipid antibodies; however, the cause of diffuse neurologic and psychiatric symptoms is largely unknown (2). Findings of conventional magnetic resonance imaging (MRI) of the brain are frequently unremarkable, and abnormalities are nonspecific (3,4). However, quantitative MRI techniques, such as magnetization transfer imaging (MTI), diffusion-weighted imaging, and MR spectroscopy (MRS), are now being assessed for their diagnostic value (4).Using MTI, a quantitative MRI technique that is sensitive to both macroscopic and microscopic CNS damage (4), abnormalities that had been invisible by conventional MRI were demonstrated in the brain parenchyma of NPSLE patients (5). Significant associations with parameters of neurologic, psychiatric, and neuropsychological function demonstrated the clinical relevance of these findings (6). Although the underlying pathogenesis of diffuse brain damage in NPSLE is largely unknown, recent findings of neuronal and astrocytic degradation products in the cerebrospinal fluid (CSF) of SLE patients have focused attention...

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Detection of cerebral involvement in patients with active neuropsychiatric systemic lupus erythematosus by the use of volumetric magnetization transfer imaging

Cited by 59 publications

References 37 publications

Detection of change in CNS involvement in neuropsychiatric SLE: A magnetization transfer study

Detection of change in CNS involvement in neuropsychiatric SLE: A magnetization transfer study

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

Selective gray matter damage in neuropsychiatric lupus

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