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

Abstract

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.

Magnetic Resonance Imaging in the Evaluation of Central Nervous System Manifestations in Systemic Lupus Erythematosus

“…MTR has been shown to be reduced in chronic NP-SLE [23,[27][28][29] and to a lesser extent in the active phase of NP-SLE [26,28]. Furthermore, follow-up MTR has been shown to reflect changes in clinical evaluation [29]. In patients with diffuse NP manifestations, MTR results have shown that the gray matter seems particularly affected, supporting the hypothesis that neuronal injury may underlie CNS manifestations [28].…”

“…Whole brain assessment can also be performed using MTR histograms, which have been shown to be lower in SLE patients with CNS involvement, independent of the presence of atrophy [20,23,[26][27][28][29]. MTR has been shown to be reduced in chronic NP-SLE [23,[27][28][29] and to a lesser extent in the active phase of NP-SLE [26,28]. Furthermore, follow-up MTR has been shown to reflect changes in clinical evaluation [29].…”

Magnetization Transfer Imaging in Premanifest and Manifest Huntington Disease: A 2-Year Follow-Up

“…Only in multiple sclerosis are optic neuritis and systemic lupus erythematosus reports available, suggesting a good potential for MTI to examine both gray and white matter for lesion evolution. [26][27][28][29] In normal aging, Ge et al (2002) 30 described, via a histogram analysis, reduction of MTR values after 40 years of age and significant group differences after 50 years of age. The groups in our study spanned exactly this age range.…”

Magnetization Transfer Imaging Provides No Evidence of Demyelination in Methotrexate-Induced Encephalopathy

“…We used the MTR in our patients as a means of imaging known to be sensitive to demyelination. 7 In a number of demyelinating conditions, such as multiple sclerosis, 14 experimentally induced demyelination in vitro, 15 and neuropsychiatric systemic lupus erythematodes, 16 studies have demonstrated the decrease of MTR.…”