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

Abstract

Central nervous system (CNS) manifestations are often observed in systemic lupus erythematosus (SLE) patients during the course of their disease. The prevalence of CNS manifestations ranges between 17 and 75%, reflecting different methods of patient selection and assessment, varying levels of assessor expertise, and lack of a consensus for diagnosing active and chronic neuropsychiatric (NP) manifestations. Postulated pathogenic mechanisms of peripheral and CNS events include vasculopathy, autoantibody effects, and systemic inflammation. Diagnosis is often difficult because of the lack of standardized diagnostic techniques. Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of CNS manifestations in SLE patients in clinical practice. MRI findings are diverse, and atrophy and hyperintense white matter lesions often correlate poorly with clinical manifestations, occurring also in patients without marked CNS signs and symptoms. We will describe MRI findings in SLE patients and discuss the usefulness of different MRI techniques in evaluating acute and chronic CNS manifestations.

Comparison of structural magnetic resonance imaging findings between neuropsychiatric systemic lupus erythematosus and systemic lupus erythematosus patients: A systematic review and meta-analysis

“…20 Common sites of WMH lesions are in the frontoparietal region, periventricular and subcortical white matter, and their presence has been recorded in both active and inactive NPSLE. 29,[47][48][49] Although evidence still persists that WMHs are not specific to NPSLE, as it was shown in SLE without overt neuropsychiatric involvement, they were found to be higher in quantity and total volume in active and past NPSLE when compared with non-NPSLE patient groups. 50 Specifically, a correlation between cognitive dysfunction, cerebrovascular syndrome and WMHs has been shown in previous studies.…”

Approach to Patients with SLE Presenting with Neurological Findings

“…Its involvement classified as primary when it is related to the disease process and secondary when it is related to other factors like medication side effect or infection. The nervous system involvement by lupus was described by Hebra and Kaposi in 1875 who described a patient with lupus and coma (Appenzeller et al,2006). Shortly after Bowen report case of psychosis and mood disturbance (Appenzeller et al, 2006).…”

“…The nervous system involvement by lupus was described by Hebra and Kaposi in 1875 who described a patient with lupus and coma (Appenzeller et al,2006). Shortly after Bowen report case of psychosis and mood disturbance (Appenzeller et al, 2006). The nervous system involvement rang from overt presentation to more subtle finding.…”

Magnetic Resonance Imaging in Neuropsychiatric Lupus

“…Furthermore, new lesions were noticed during onset of new neuropsychiatric manifestations, and resolution of lesions was found with clinical improvement 25, 41, 42 . Quantitative methods are increasingly proposed for the quantification and follow-up of the WMH in NPSLE, as they can function as an independent predictor for the NPSLE activity and injury, holding promise to open a new line of follow-up of NPSLE patients and their response to therapy, similar to the monitoring of multiple sclerosis 32, 34, 38 .…”

“…Up to 40–50% of NPSLE patients had no brain abnormalities on conventional MRI 8, 11, 30, 32, 35, 61 . Nonetheless, advanced MRI sequences in NPSLE demonstrated underlying abnormalities in normal appearing white and grey matter, which shows the limitations of conventional sequences 51, 62, 63 .…”