Multi-voxel proton magnetic resonance spectroscopy changes in neuropsychiatric lupus patients

Abstract

How to cite this article: Wang P.I., Harris R.R. Multi-voxel proton magnetic resonance spectroscopy changes in neuropsychiatric lupus patients. S Afr J Rad. 2016;20(1), a974. http://dx. doi.org/10. 4102/sajr.v20i1.974 Systemic lupus erythematosus (SLE) is a chronic autoimmune disease afflicting numerous organs of the body, affecting 0.05% -0.1% of the general population.1,2 Neuropsychiatric SLE (NPSLE) is one of the most severe manifestations of SLE, with increased morbidity and mortality. 3To be diagnosed with NPSLE, one must have SLE and one of the 19 symptoms/disorders as defined by the American College of Rheumatology (ACR) (Box 1). 4 Unfortunately, many of the case definitions for NPSLE are common and nonspecific, such as anxiety disorder or headache, and this limits the specificity of NPSLE. Therefore, a more definitive, or quantitative approach would be helpful in diagnosing NPSLE for treatment, therapy and prognostic reasons.Magnetic resonance imaging (MRI) is frequently used to diagnose or exclude main brain alterations and has become part of the routine clinical work-up of SLE patients to evaluate them for complications of the disease that may contribute to neurologic sequelae, and for helping to diagnose or exclude cerebral pathologies such as haemorrhage, cerebral venous thrombosis, or stroke. Abnormal conventional MRI findings are common in both SLE and NPSLE patients, and range from nonspecific small punctate focal hyperintense lesions in periventricular white matter, to more severe findings such as cortical atrophy, ventricular dilation, cerebral oedema, cerebral infarctions and intracranial haemorrhage. 5,6 These findings are attributed to different mechanisms, including thrombosis, vasculopathy and antibody-mediated neuronal injury.Although clinical assessment is the cornerstone of the NPSLE diagnosis, this diagnosis can be difficult to make and is frequently presumptive. Previous magnetic resonance spectroscopy (MRS) studies have demonstrated changes of the brain metabolites in SLE patients both in abnormal-and normal-appearing white matter and in more recent changes in glutamine and glutamate in the insular region in both SLE and NPSLE patients. 7 Common metabolites previously Purpose: In this prospective study, we used 2D chemical shift imaging (CSI), a multi-voxel proton spectroscopy technique, to evaluate the brain metabolites on conventional magnetic resonance imaging (MRI) in normal-appearing white and grey matter in systemic lupus erythematosus (SLE) patients with neuropsychiatric symptoms (NPSLE); without neuropsychiatric symptoms (non-NPSLE); and healthy controls (HCs). Our objective was to find metabolites that discriminated NPSLE patients from the non-NPSLE and HC cohorts. Materials and methods:The study included 23 NPSLE patients, 20 non-NPSLE patients, and 21 HCs. A clinical assessment including the SLE disease activity index (SLEDAI) and systemic lupus international collaborating clinics (SLICC) scores was conducted. All patients underwent conventional MRI and 2D CSI technique ...

Proton magnetic resonance spectroscopy (1H-MRS) in rheumatic autoimmune diseases: A systematic review

“…Twenty studies were cross-sectional 18,28–36,38,40–45,47–49 and six studies were longitudinal. 5 , 6,27,37,39,46…”

“…6,18,30–32,35,44,46 Nine articles used the manufacturer’s supplied spectroscopy software package. 5 , 27,29,33,37,39,47–49…”

“…5 , 6,27,29–31,35,36,39,41 Individual NP manifestations were described in twelve studies. 5 , 18,27–30,32,35–37,39,43 SLE disease activity (SLEDAI ou SLEDAI-2K) was reported in 6 studies. 5 , 6,27,30,37,43…”

“…Most studies showed a reduction of NAA/Cr ratio in SLE, 5 , 6,18,27,28,30,35–42 SSc, 45,46 pSS, 47 and RA 49 in different brain regions.…”

“…27 Abnomal diffusivities of Cho and elevation of Cho/Cr ratios in WM are potentially unique markers for glial reactivity in response to inflammation and involvement of cerebral myelin. 27,30,31,34,39,49…”