Evidence of central nervous system damage in patients with neuropsychiatric systemic lupus erythematosus, demonstrated by magnetization transfer imaging

Abstract

Objective. The clinical symptoms of neuropsychiatric systemic lupus erythematosus (NPSLE) are usually reversible, but whether the associated brain damage is also reversible is still a matter of debate. Since magnetization transfer imaging (MTI) is more sensitive than conventional magnetic resonance imaging (MRI) in demonstrating brain damage, it has become a useful tool in the detection and quantification of diffuse brain disorders such as multiple sclerosis. In this study, MTI was applied to investigate whether central nervous system (CNS) damage is present in patients with a history of NPSLE.Methods. Eleven female patients with a history of NPSLE and no previous or concurrent primary neurologic or psychiatric disease (ages 17-49 years), 11 female patients with SLE without a history of NPSLE (non-NPSLE; ages 15-51 years), and 10 healthy female controls (ages 17-47 years) underwent MTI. From these MTI scans, quantitative data on the uniformity of the brain parenchyma and atrophy were derived.Results. One NPSLE and 1 non-NPSLE patient were excluded from this study due to infarctions detected with conventional MRI. MTI measures normalized for intracranial volume, reflecting abnormalities of the brain parenchyma as well as atrophy, were lower (P < 0.001) in the NPSLE group than in both control groups. A higher (P < 0.005) mean ratio of cerebrospinal fluid to intracranial volume, indicative of atrophy, was present in the NPSLE group compared with either the non-NPSLE patients or healthy controls. Still, the MTI measures solely reflecting uniformity of the brain parenchyma (normalized for brain volume) were also significantly (P < 0.001) lower in the NPSLE patients than in both control groups.Conclusion. This study demonstrates that using MTI, CNS damage can be demonstrated in patients with a history of NPSLE. MTI might, therefore, be an alternative and sensitive tool to detect brain injury in NPSLE, and might also be useful in studying the natural history of the disease.The clinical symptoms of diffuse neuropsychiatric systemic lupus erythematosus (NPSLE) are usually reversible, but it is unknown whether the underlying brain disorder is also reversible. Although punctate areas of increased signal (PAIS) or atrophy can be found in NPSLE patients with the use of diagnostic imaging techniques, these characteristics are also demonstrated in SLE patients who do not have NPSLE (1). Still, functional imaging techniques have demonstrated a variety of abnormalities that are found strictly in NPSLE patients (2-10). Some of the results have suggested transient abnormalities, whereas others have indicated lasting damage.Magnetization transfer imaging (MTI) is a magnetic resonance imaging (MRI) technique that has 2 advantages over conventional MRI: it seems to be more sensitive to structural brain damage, and it permits easy and robust quantification of such structural damage (11). MTI has been applied as a method to detect and quantify diffuse diseases of the brain, such as multiple sclerosis (MS). In MS patients, MTI estimates...

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

“…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).…”

“…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).…”

“…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).…”

Lobar Distribution of Changes in Gray Matter and White Matter in Memory Clinic Patients: Detected Using Magnetization Transfer Imaging

“…Furthermore, our study is in line with previous studies that reported that MTI peak height is the most sensitive MTR parameter in detecting brain pathology. 13,26,27 Mean MTR only detected differences between patients with AD and subjects with normal cognition, whereas peak height also detected differences between subjects with normal cognition and patients with MCI.…”

Structural neural networks subserving oculomotor function in first-episode schizophrenia

“…The MT signal is closely related to macromolecular density, which is mainly dependent upon cell membrane proteins and phospholipids in grey matter and myelin in white matter. Pathological processes that damage macromolecules and brain parenchymal integrity, particularly cell membranes and myelin, cause MTR reductions (Lexa et al 1994;Mottershead et al 1998;Van Waesberghe et al 1999;Bosma et al 2000;Van Buchem and Tofts, 2000). The specific molecules responsible for the MT signal in grey matter are yet to be specified, although creatine, choline and n-acetyl aspartate related compounds are thought to contribute (Meyerhoff, 1999).…”