Neuropsychiatric lupus or not? Cerebral hypoperfusion by perfusion-weighted MRI in normal-appearing white matter in primary neuropsychiatric lupus erythematosus

Papadaki, Efrosini; Fanouriakis, Antonis; Kavroulakis, Eleftherios; Karageorgou, Dimitra; Sidiropoulos, Prodromos; Βertsias, George; Simos, Panagiotis G.; Boumpas, Dimitrios T.

doi:10.1136/annrheumdis-2017-212285

Cited by 44 publications

(44 citation statements)

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“…At first, the total WM was segmented using the Robust Statistics Segmenter tool and then the total WM volume was computed using the Model Maker tool. Lesion burden of small (<1 cm) WMH on T 2 /FLAIR sequences was classified according to their absolute number: grade 0 (no WMHs), grade 1 (mild: 1–5 WMHs), grade 2 (moderate: 6–10 WMHs), or grade 3 (severe: >10 WMHs) …”

Section: Methodsmentioning

confidence: 99%

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Age‐related deep white matter changes in myelin and water content: A T₂ relaxometry study

Papadaki

Kavroulakis

Kalaitzakis

et al. 2019

Magnetic Resonance Imaging

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Background According to the retrogenesis hypothesis, the rate of age‐related changes in white matter (WM) myelin content varies between early myelinating (parietal, occipital) and late myelinating (prefrontal, lateral–posterior temporal) areas. The multiecho spin echo (MESE), PD‐to‐T2‐weighted sequence provides an index of myelin content (myelin water fraction [MWF]) derived from measurements of myelin water (via the short T2 component [10–50 msec]) and intra‐ and extracellular water (via the long T2 component [>50–200 msec]). Purpose To assess the shape and regional variations in the rate of age‐related myelin and water content changes in deep WM regions using the MESE sequence. Study Type Prospective, cross‐sectional. Population In all, 90 healthy adults aged 22–81 years. Field Strength/Sequence 1.5T/ T1w, T2w, fluid attenuated inversion recovery (FLAIR), MESE sequences. Assessment Short T2, long T2, and MWF values were measured in prefrontal, parietal, lateral–posterior temporal, and occipital normal‐appearing WM (NAWM) areas. Statistical Tests Linear and quadratic effects of age on long T2 and MWF were assessed through regression analyses. Regional variations in the effect of age on long T2 and MWF values at both the individual and group level were examined, using regression and analysis of covariance (ANCOVA) analyses, respectively, controlling for total WM volume. Results The rate of age‐related changes in long T2 and MWF was higher for older persons and a significant increase or decline, respectively, was first noted at 60–69 years (P < 0.0033). MWF values peaked earlier (at 30 years of age) and displayed a steeper age‐related reduction in prefrontal and lateral–posterior temporal NAWM as compared with the occipital lobes (P < 0.05). The opposite pattern of age‐related effect was found for long T2 values. Data Conclusion Significant age‐related reductions in myelin content were closely followed by corresponding increases in intra‐ and extracellular water content. These changes were more pronounced among elderly people and followed an anterior–posterior pattern. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1393–1404.

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Section: Methodsmentioning

confidence: 99%

“…Lesion burden of small (<1 cm) WMH on T 2 /FLAIR sequences was classified according to their absolute number: grade 0 (no WMHs), grade 1 (mild: 1-5 WMHs), grade 2 (moderate: 6-10 WMHs), or grade 3 (severe: >10 WMHs). 28…”

Section: Mr Image Acquisitionmentioning

confidence: 99%

Age‐related deep white matter changes in myelin and water content: A T₂ relaxometry study

Papadaki

Kavroulakis

Kalaitzakis

et al. 2019

Magnetic Resonance Imaging

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“…The cerebral hypoperfusion of frontal, temporal, and partial areas has been observed in NPSLE patients by positron emission tomography (PET) and single‐photon emission computed tomography (SPECT) studies, which could provide early biomarkers for SLE (Kodama et al, ; Sahebari, Rezaieyazdi, Khodashahi, Abbasi, & Ayatollahi, ). Recently, MR perfusion imaging studies with dynamic susceptibility contrast (DSC) reported that the cerebral blood volume (CBV), and cerebral blood flow (CBF) of certain specific brain regions (e.g., posterior cingulate gyrus) were highly related to NPSLE (Gasparovic et al, ; Papadaki et al, ; Wang et al, ; Zimny et al, ). Compared to normal controls (NC), both hyperperfusion and hypoperfusion, were illustrated within gray (GM) and white matter (WM) in SLE patients (Gasparovic et al, ; Papadaki et al, ; Wang et al, ; Zimny et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, MR perfusion imaging studies with dynamic susceptibility contrast (DSC) reported that the cerebral blood volume (CBV), and cerebral blood flow (CBF) of certain specific brain regions (e.g., posterior cingulate gyrus) were highly related to NPSLE (Gasparovic et al, ; Papadaki et al, ; Wang et al, ; Zimny et al, ). Compared to normal controls (NC), both hyperperfusion and hypoperfusion, were illustrated within gray (GM) and white matter (WM) in SLE patients (Gasparovic et al, ; Papadaki et al, ; Wang et al, ; Zimny et al, ). Previous studies have demonstrated hypoperfusion within GM and WM in NPSLE compared to non‐NPSLE (Papadaki et al, ; Wang et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Compared to normal controls (NC), both hyperperfusion and hypoperfusion, were illustrated within gray (GM) and white matter (WM) in SLE patients (Gasparovic et al, ; Papadaki et al, ; Wang et al, ; Zimny et al, ). Previous studies have demonstrated hypoperfusion within GM and WM in NPSLE compared to non‐NPSLE (Papadaki et al, ; Wang et al, ). Accumulated evidence indicates that abnormal perfusion (CBF or CBV) is not specific to NPSLE because perfusion is also altered in non‐NPSLE patients.…”

Section: Introductionmentioning

confidence: 99%

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Different patterns of cerebral perfusion in SLE patients with and without neuropsychiatric manifestations

Zhuo

Duan

et al. 2019

Human Brain Mapping

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To investigate brain perfusion patterns in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric systemic lupus erythematosus (NPSLE and non-NPSLE, respectively) and to identify biomarkers for the diagnosis of NPSLE using noninvasive three-dimensional (3D) arterial spin labeling (ASL). Thirty-one NPSLE and 24 non-NPSLE patients and 32 age-and sex-matched normal controls (NCs) were recruited. Three-dimensional ASL-MRI was applied to quantify cerebral perfusion. Whole brain, gray (GM) and white matter (WM), and voxel-based analysis (VBA) were performed to explore perfusion characteristics. Correlation analysis was performed to find the relationship between the perfusion measures, lesion volumes, and clinical variables. Receiver operating characteristic (ROC) analysis and support vector machine (SVM) classification were applied to differentiate NPSLE patients from non-NPSLE patients and healthy controls. Compared to NCs, NPSLE patients showed increased cerebral blood flow (CBF) within WM but decreased CBF within GM, while non-NPSLE patients showed increased CBF within both GM and WM. Compared to non-NPSLE patients, NPSLE patients showed significantly reduced CBF in the frontal gyrus, cerebellum, and corpus callosum. CBF within several brain regions such as cingulate and corpus callosum showed significant correlations with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborating Clinics (SLICC) damage index scores. ROC analysis showed moderate performance in distinguishing NPSLE from non-NPSLE patients with AUCs > 0.7, while SVM analysis demonstrated that CBF within the corpus callosum achieved an accuracy of 83.6% in distinguishing NPSLE from non-NPSLE patients. Different brain perfusion patterns were observed between NPSLE and non-NPSLE patients. CBF measured by noninvasive 3D ASL could be a useful biomarker for the diagnosis and disease monitoring of NPSLE and non-NPSLE patients. K E Y W O R D S 3D arterial spin labeling, neuropsychiatric systemic lupus erythematosus, perfusion, systemic lupus erythematosus Zhizheng Zhuo and Li Su contributed equally to this study.

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Altered cerebral perfusion in children with Langerhans cell histiocytosis after chemotherapy

Han

Kim

Shpanskaya

et al. 2019

Pediatric Blood & Cancer

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Background and purposeChildren with Langerhans cell histiocytosis (LCH) may develop a wide array of neurological symptoms, but associated cerebral physiologic changes are poorly understood. We examined cerebral hemodynamic properties of pediatric LCH using arterial spin‐labeling (ASL) perfusion magnetic resonance imaging (MRI).Materials and methodsA retrospective study was performed in 23 children with biopsy‐proven LCH. Analysis was performed on routine brain MRI obtained before or after therapy. Region of interest (ROI) methodology was used to determine ASL cerebral blood flow (CBF) (mL/100 g/min) in the following bilateral regions: angular gyrus, anterior prefrontal cortex, orbitofrontal cortex, dorsal anterior cingulate cortex, and hippocampus. Quantile (median) regression was performed for each ROI location. CBF patterns were compared between pre‐ and posttreatment LCH patients as well as with age‐matched healthy controls.ResultsSignificantly reduced CBF was seen in posttreatment children with LCH compared to age‐matched controls in angular gyrus (P = .046), anterior prefrontal cortex (P = .039), and dorsal anterior cingulate cortex (P = .023). Further analysis revealed dominant perfusion abnormalities in the right hemisphere. No significant perfusion differences were observed in the hippocampus or orbitofrontal cortex.ConclusionPerfusion in specific cerebral regions may be consistently reduced in children with LCH, and may represent effects of underlying disease physiology and/or sequelae of chemotherapy. Studies that combine a formal cognitive assessment and hemodynamic data may further provide insight into perfusion deficits associated with the disease and the potential neurotoxic effects in children treated by chemotherapy.

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Neuropsychiatric lupus or not? Cerebral hypoperfusion by perfusion-weighted MRI in normal-appearing white matter in primary neuropsychiatric lupus erythematosus

Abstract: Primary NPSLE is characterised by significant hypoperfusion in cerebral white matter that appears normal on cMRI. The combination of DSC-MRI-measured blood flow in the brain semioval centre with conventional MRI may improve NPSLE diagnosis.

Cited by 44 publications

References 46 publications

Age‐related deep white matter changes in myelin and water content: A T₂ relaxometry study

Age‐related deep white matter changes in myelin and water content: A T₂ relaxometry study

Different patterns of cerebral perfusion in SLE patients with and without neuropsychiatric manifestations

Altered cerebral perfusion in children with Langerhans cell histiocytosis after chemotherapy

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Neuropsychiatric lupus or not? Cerebral hypoperfusion by perfusion-weighted MRI in normal-appearing white matter in primary neuropsychiatric lupus erythematosus

Abstract: Primary NPSLE is characterised by significant hypoperfusion in cerebral white matter that appears normal on cMRI. The combination of DSC-MRI-measured blood flow in the brain semioval centre with conventional MRI may improve NPSLE diagnosis.

Cited by 44 publications

References 46 publications

Age‐related deep white matter changes in myelin and water content: A T2 relaxometry study

Age‐related deep white matter changes in myelin and water content: A T2 relaxometry study

Different patterns of cerebral perfusion in SLE patients with and without neuropsychiatric manifestations

Altered cerebral perfusion in children with Langerhans cell histiocytosis after chemotherapy

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Product

Resources

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Age‐related deep white matter changes in myelin and water content: A T₂ relaxometry study

Age‐related deep white matter changes in myelin and water content: A T₂ relaxometry study