Systemic Lupus Erythematosus: Brain MR Imaging and Single-Voxel Hydrogen 1 MR Spectroscopy

Lim, Myung Kwan; Suh, Chang Hae; Kim, Hyung Jin; Cho, Young Kook; Choi, Seung Ho; Kang, Jee-Hyun; Park, Won; Lee, Jun Young

doi:10.1148/radiology.217.1.r00oc1543

Cited by 56 publications

(32 citation statements)

References 26 publications

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“…30,31 Elevated Cho/Cr levels can also be seen in malignant neoplasms [32][33][34][35][36] as well as in the context of CNS infection [37][38][39] or inflammatory conditions such as neuropsychiatric lupus erythematosus. [40][41][42][43][44] Although neither demyelination nor malignant neoplasms are likely to be the cause of these abnormalities in FM, changes in Cho/Cr levels (though nonspecific) do provide a sensitive indication of altered brain metabolic activity. The exact pathophysiology that could explain altered Cho/Cr levels in FM is unclear.…”

Section: Discussionmentioning

confidence: 99%

Proton MR Spectroscopy in the Evaluation of Cerebral Metabolism in Patients with Fibromyalgia: Comparison with Healthy Controls and Correlation with Symptom Severity

Petrou¹,

Harris²,

Foerster³

et al. 2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Widespread pain sensitivity in patients with fibromyalgia (FM) suggests a central nervous system (CNS)-processing problem. Therefore, it is conceivable that metabolic alterations exist in pain-processing brain regions of people with FM compared with healthy controls (HC) and that such metabolic data could correlate with clinical symptoms. The purpose of this study was to test these hypotheses using proton MR spectroscopy ( 1 H-MR spectroscopy).

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Section: Discussionmentioning

confidence: 99%

Proton MR Spectroscopy in the Evaluation of Cerebral Metabolism in Patients with Fibromyalgia: Comparison with Healthy Controls and Correlation with Symptom Severity

Petrou¹,

Harris²,

Foerster³

et al. 2008

AJNR Am J Neuroradiol

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“…A number of studies utilized magnetic resonance spectroscopy (MRS) as a measure of neuronal metabolism to more clearly characterize cerebral disease in SLE from other autoimmune diseases (Friedman et al 1998;Lim et al 2000;Peterson et al 2005;Sabet et al 1998). Nacetyl aspartate (NAA), a marker of axonal loss, was reduced in normal appearing white and gray matter, as well as in lesions (Peterson et al 2005).…”

Section: Brain Imaging Findings In Slementioning

confidence: 99%

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

et al. 2008

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In this manuscript, we review literature describing the neuropsychological and brain imaging characteristics of systemic lupus erythematosus (SLE) patients. The findings are compared and contrasted with multiple sclerosis (MS) studies, revealing similarities and differences of interest to clinicians and researchers. While cognitive impairment is somewhat less common in SLE than MS, the diseases share a similar cognitive profile with deficits most prominent on tests emphasizing the speed of information processing, working memory, and visual/spatial learning, and memory. In early or more mildly affected patients, diffuse white matter damage, which may not be apparent on conventional brain imaging, plays a major role in clinical presentation and cognitive testing. The causes of white matter damage are very different, however, and in later stages of the disease MS and SLE appear to give rise to different forms of cerebral pathology. MS may be characterized by increasing brain atrophy affecting especially the cortical and deep gray matter, at least after conversion to secondary progressive course. There is less evidence for neurodegenerative changes in SLE, but patients are increasingly at risk for cerebrovascular disease. We conclude by offering some suggestions for future clinical and imaging research. KeywordsSystemic lupus erythematosus; Multiple sclerosis; Cognition; Memory; Processing speed; MRI; Effect size Systemic lupus erythematosus (SLE) is a relapsing-remitting autoimmune disease with wide ranging organ involvement and clinical symptoms varying from mild and transient symptoms to death. Cognitive impairment is reported in SLE, even among those patients without documented or overt signs of central nervous system (CNS) involvement. Presumably, cognitive disorder is the result of underlying brain disease although the precise mechanisms remain to be elucidated. The prevalence and degree of cognitive impairment is also uncertain.In this article we will endeavor to evaluate the evidence for neuropsychological impairment in SLE, and to compare the findings with that of MS, another immunological disorder whose symptoms wax and wane and which affects women more than men. Unlike SLE, MS is a disease that always impacts the CNS, and the causes of cognitive disorder in MS are better understood.

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“…Reduced NAA levels thought to reflect neuronal injury/death Zardi et al, 19 Yaniv et al 22 and Lim et al 25 …”

Section: Magnetisation Transfer Imaging (Mti)mentioning

confidence: 99%

“…46 A variety of MRI investigation descriptions were provided. In 10 papers, T1, T2 and fluid-attenuated inversion recovery (FLAIR) were used; 20 25 and MRI, SPECT. 42 Five studies were undertaken in the United States, 21,36,41,44,45 three in Japan, 34,35,46 two in South Korea, 25,32 two from the Netherlands 20,24 and two from Brazil.…”

Section: Study Quality Assessmentmentioning

confidence: 99%

“…In 10 papers, T1, T2 and fluid-attenuated inversion recovery (FLAIR) were used; 20 25 and MRI, SPECT. 42 Five studies were undertaken in the United States, 21,36,41,44,45 three in Japan, 34,35,46 two in South Korea, 25,32 two from the Netherlands 20,24 and two from Brazil. 38,39 Single studies were undertaken in Turkey, 37 China, 27 Poland, 40 Canada, 42 Germany 43 and Spain, 33 while one study was conducted in both Spain and the United Kingdom.…”

Section: Study Quality Assessmentmentioning

confidence: 99%

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

Amin

Kaul

Smith

et al. 2017

Rheumatology Practice and Research

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Introduction: Neuropsychiatric systemic lupus erythematosus is often clinically challenging to diagnose, treat and monitor. Although brain magnetic resonance imaging is frequently performed before lumbar puncture in neuropsychiatric systemic lupus erythematosus, it is not clear from the literature whether specific brain magnetic resonance imaging findings are associated with distinct clinical features of neuropsychiatric systemic lupus erythematosus. Methods: We conducted a systematic review and meta-analysis on published studies of neuropsychiatric systemic lupus erythematosus including brain magnetic resonance imaging and the 1999 American College of Rheumatology-defined clinical neuropsychiatric systemic lupus erythematosus syndromes to determine their relationship. Pooled prevalence and risk ratio for distinct neuropsychiatric systemic lupus erythematosus associations were determined with 95% confidence intervals. Results: Of 821 studies screened, 21 fulfilled inclusion criteria. A total of 818 participants were evaluated (91% female) with 1064 neuropsychiatric systemic lupus erythematosus episodes assessed. Neuropsychiatric systemic lupus erythematosus features included headache (24%), seizures (19%), cerebrovascular disease (18%), cognitive dysfunction (15%) and acute confusional state (14%). Normal magnetic resonance imaging was significant for anxiety disorder (risk ratio: 9.00; 95% confidence interval: 2.40, 33.79), autonomic disorder (risk ratio: 7.00; 95% confidence interval: 0.51, 96.06) and plexopathy (risk ratio: 5.00; 95% confidence interval: 0.81, 31.00). Highest risk ratio of neuropsychiatric systemic lupus erythematosus syndrome with abnormal magnetic resonance imaging was observed for cerebrovascular disease (risk ratio: 0.15; 95% confidence interval: 0.10, 0.24) and demyelination (risk ratio: 0.11; 95% confidence interval: 0.02, 0.72). Conclusion: Normal magnetic resonance imaging in neuropsychiatric systemic lupus erythematosus was the most significant correlate from our meta-analysis for psychological symptoms including anxiety and peripheral nerve features of autonomic disorder and plexopathy. The main abnormal brain magnetic resonance imaging correlates included cerebrovascular disease and demyelination. Brain magnetic resonance imaging correlates poorly with neuropsychiatric systemic lupus erythematosus features, and specific clinical symptoms should be the main determinants of performing magnetic resonance imaging rather than presence of neuropsychiatric systemic lupus erythematosus per se.

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Systemic Lupus Erythematosus: Brain MR Imaging and Single-Voxel Hydrogen 1 MR Spectroscopy

Abstract: In patients with SLE, (1)H MR spectroscopic findings seem to reflect the cerebral metabolic disturbance related to the severity of the neuropsychiatric symptoms and are not related to the presence of abnormal MR imaging findings.

Cited by 56 publications

References 26 publications

Proton MR Spectroscopy in the Evaluation of Cerebral Metabolism in Patients with Fibromyalgia: Comparison with Healthy Controls and Correlation with Symptom Severity

Proton MR Spectroscopy in the Evaluation of Cerebral Metabolism in Patients with Fibromyalgia: Comparison with Healthy Controls and Correlation with Symptom Severity

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

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

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