Evaluation of oxygen extraction fraction in systemic lupus erythematosus patients using quantitative susceptibility mapping

Abstract

The purposes of this study are to assess the oxygen extraction fraction (OEF) changes on MRI-based quantitative susceptibility mapping (QSM) in systemic lupus erythematosus (SLE) patients and to determine whether QSM-OEF is associated with disease activity in SLE. We enrolled 42 SLE patients and 20 healthy subjects (HS) who had no pathologies on conventional brain MRI. Disease activity was assessed using SLE Disease Activity Index (SLEDAI). For the measurement of QSM-OEF, QSM data were analysed using the Perfusion Mismatch Analyzer software program. Spearman's or Pearson's correlation coefficients were calculated, and independent predictors were identified through a multiple linear regression analysis. QSM-OEF was significantly higher in SLE than that in HS (51.3 ± 10.1 vs. 40.5 ± 3.7, p < 0.001). QSM-OEF was positively correlated with SLEDAI and the presence of neuropsychiatric symptom (NPS) scores (ρ = 0.663, p < 0.001 and ρ = 0.340, p = 0.028). At multiple linear regression analysis, SLEDAI and NPS were independently associated with QSM-OEF (standardized β = 0.426, p = 0.016 and standardized β = 6.148, p = 0.029). In the SLE patients, QSM-OEF is associated with disease activity, which might predict an increased risk of stroke in SLE.

Validation of T2‐based oxygen extraction fraction measurement with 15O positron emission tomography

“…For example, in cerebral arterial occlusive diseases, it is known that higher OEF predicts higher risk for stroke 4,5,7,8 . Diminished OEF was reported in patients with mild cognitive impairment 1 and multiple sclerosis, 9 while increased OEF was demonstrated in patients with Moyamoya disease, 3,14 systemic lupus erythematosus, 29 hepatic encephalopathy, 51 or end‐stage renal disease 52 . Traditionally, 15 O‐PET is the method of choice to investigate brain OEF abnormalities 4,5,7,8,14 .…”

“…Among these techniques, some provide a whole‐brain or global estimation of cerebral OEF, 15,16,20,21 while some can measure regional OEF 17‐19,22‐28 . Many of these MRI‐based methods have found clinical utility in various diseases 1‐3,6,9,29,30 . However, few studies have validated MRI‐based OEF estimations with gold standard 15 O‐PET, 31 which would be important to ensure the accuracy of these methods and facilitate their broader clinical applications.…”

“…[17][18][19][22][23][24][25][26][27][28] Many of these MRI-based methods have found clinical utility in various diseases. [1][2][3]6,9,29,30 However, few studies have validated MRI-based OEF estimations with gold standard 15 O-PET, 31 which would be important to ensure the accuracy of these methods and facilitate their broader clinical applications. T 2 -relaxation-under-spin-tagging (TRUST) is a widely used MRI technique to measure whole-brain OEF based on the relationship between blood T 2 and oxygenation.…”

The Spatiotemporal Evolution of MRI-Derived Oxygen Extraction Fraction and Perfusion in Ischemic Stroke

“…Positron emission tomography (PET) has so far been used as the gold standard for cerebral OEF mapping (Baron, 1985;Sette et al, 1989;Kudo et al, 2016), but radiation exposure is unavoidable and it consumes a large amount of expensive materials. As a result, substantial studies (Stout et al, 2018;Cherukara et al, 2019;Hubertus et al, 2019;O'Brien et al, 2019;Ma et al, 2020) have emerged in the field of magnetic resonance imaging using either phase or magnitude information for OEF measurement in cerebrovascular diseases (Uwano et al, 2017;Kato et al, 2018;Stone et al, 2019), neurodegenerative disorder (Lin et al, 2019), and other systemic diseases (Fields et al, 2018;Miyata et al, 2019). Advancement in imaging technology is of great benefit to the diagnosis and therapeutic strategy making for ischemic stroke; however, the oxygenation status of an ischemic brain tissue has a broad range depending on the blood supply and the time from stroke onset, and there are few studies systematically reporting the oxygenation status through different time points and blood flow.…”

Quantitative Susceptibility Mapping: Technical Considerations and Clinical Applications in Neuroimaging

“…Therefore, QSM can detect SLE even at a subclinical stage, while conventional MRI shows no changes. Miyata et al studied the OEF in SLE patients using QSM 81 and recorded elevated values in the brain of SLE patients owing to reactive changes of the small vessels arising from neuroinflammatory activity. OEF in SLE patients also correlates with systemic disease activity.…”