Magnetic Resonance Imaging in Neuropsychiatric Lupus

Abstract

Neuropsychiatric lupus is a major diagnostic challenge, and a main cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Magnetic resonance imaging (MRI) is, by far, the main tool for assessing the brain in this disease. Conventional and advanced MRI techniques are used to help establishing the diagnosis, to rule out alternative diagnoses, and recently, to monitor the evolution of the disease. This review explores the neuroimaging findings in SLE, including the recent advances in new MRI methods.

Automated Detection of Lupus White Matter Lesions in MRI

“…WML are the most common radiological finding in neurolupus. They are non-specific findings, being frequently observed in older age groups, migraine, chronic diseases, heart diseases, diabetes, high-blood pressure, dyslipidemia, and other vascular risk factors, although they are also present in asymptomatic subjects without known diseases (Sarbu et al, 2015c ). However, WML are found in 40–60% of neurolupus patients, even at the onset of the disease, and many previous reports showed a higher frequency of WML in neurolupus when compared with lupus without neurolupus and general population (Castellino et al, 2008 ; Wardlaw et al, 2013 ; Sarbu et al, 2015b , c ).…”

“…Figures 2C,D shows the original image and the tissue segmentation result of two slices forward, where the candidates marked in red are attached to GM and therefore eliminated with the neighborhood constraint. (3) Lesion location: since Lupus lesions are rarely present in the posterior fossa (Sarbu et al, 2015b , c ), and this particular area is highly prone to present hyperintense artifacts, we have decided to exclude this region when looking for possible lesion candidates. This is done automatically by registering an atlas with the corresponding structure segmentation to the T1w image.…”

“…Magnetic resonance imaging (MRI) is the gold standard technique for studying the brain in lupus (Sarbu et al, 2015c ). The neuroimaging findings are classified as small or large vessel disease, and inflammatory-type lesions (Sarbu et al, 2015b ).…”

“…Small vessel disease is represented by white-matter hyperintensities/lesions, recent small subcortical infarcts, lacunes, microbleeds, and brain atrophy (Wardlaw et al, 2013 ). WML are the most common findings of small vessel disease seen in lupus, and represent small T2-hyperintensities following the distribution of the white matter (periventricular, deep, subcortical), and including also the white matter at the basal ganglia, and cerebellum (Sarbu et al, 2015b , c ). During the last years, WML have been shown to function as an independent predictor for the neurolupus activity and injury, and quantitative methods are increasingly proposed for the quantification and follow-up of the WML in neurolupus.…”

Spectrum of central nervous system involvement in rheumatic diseases: pictorial essay

“…In rare cases, bilateral, symmetric intraparenchymal calcifications are observed, especially in the basal nuclei, case reports citing a probable relationship with vasculopathy (5) . Another unusual form is a demyelinating disease, similar to multiple sclerosis, known as lupoid sclerosis.…”