Conventional brain magnetic resonance imaging in the longitudinal evaluation of newly diagnosed systemic lupus erythematosus patients: a retrospective analysis from a single-centre cohort

Introduction Neuropsychiatric (NP) manifestations occur mostly in the early phases of the systemic lupus erythematosus (SLE) course. Nonspecific alterations are evident in conventional brain magnetic resonance imaging (MRI), regardless of clinically overt NP symptoms. The main aims of this study were to assess the prevalence of MRI abnormalities in newly diagnosed SLE, and to evaluate the impact of MRI changes during follow-up (FU) and the clinical course of NP symptoms. Materials and methods Newly diagnosed SLE patients with a baseline brain MRI and with available repeated MRI during FU were retrospectively evaluated. White-matter lesions and atrophy were recorded, comparing NPSLE and non-NPSLE patients. Cox proportional hazard models were used to compare NP events during FU with MRI data. Results Forty-four patients were included, 22 with NP events attributed to SLE. The baseline MRI scan was abnormal in 21 patients (47.73%). New NP events occurred in 17 patients, and worsening was found in repeated MRIs in 12 (27.27%). A worsening of MRI was associated with higher occurrence of new NP events during FU (adjusted hazard ratio 3.946 (1.175–13.253)). Conclusion Baseline MRI is useful in patients with an early diagnosis of SLE, allowing comparison with subsequent scans. In our study, radiological worsening of repeated brain MRI was associated with new NP events.

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A comparison of executive function in newly-diagnosed systemic lupus erythematosus (SLE) patients and controls: A functional magnetic resonance imaging (fMRI) study

Brain Behavior and Immunity ◽

10.1016/j.bbi.2011.07.037 ◽

2011 ◽

Vol 25 ◽

pp. S188

Author(s):

R.C. Ho ◽

R. Tao ◽

A. Mak

Keyword(s):

Magnetic Resonance Imaging ◽

Systemic Lupus Erythematosus ◽

Executive Function ◽

Magnetic Resonance ◽

Lupus Erythematosus ◽

Newly Diagnosed ◽

Functional Magnetic Resonance ◽

Resonance Imaging ◽

Systemic Lupus ◽

Fmri Study

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Combined Brain/Heart Magnetic Resonance Imaging in Systemic Lupus Erythematosus

Current Cardiology Reviews ◽

10.2174/1573403x15666190801122105 ◽

2020 ◽

Vol 16 (3) ◽

pp. 178-186 ◽

Cited By ~ 2

Author(s):

Sophie Mavrogeni ◽

Loukia Koutsogeorgopoulou ◽

Theodoros Dimitroulas ◽

George Markousis-Mavrogenis ◽

Kyriaki Boki ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Heart Failure ◽

Systemic Lupus Erythematosus ◽

Magnetic Resonance ◽

Lupus Erythematosus ◽

Cardiac Involvement ◽

Brain Mri ◽

Resonance Imaging ◽

Systemic Lupus ◽

Neuropsychiatric Sle

: Cardiovascular Disease (CVD) in Systemic Lupus Erythematosus (SLE) and Neuropsychiatric SLE (NPSLE) has an estimated prevalence of 50% and 40%, respectively and both constitute major causes of death among SLE patients. In this review, a combined brain/heart Magnetic Resonance Imaging (MRI) for SLE risk stratification has been proposed. : The pathophysiologic background of NPSLE includes microangiopathy, macroscopic infarcts and accelerated atherosclerosis. Classic brain MRI findings demonstrate lesions suggestive of NPSLE in 50% of the NPSLE cases, while advanced MRI indices can detect pre-clinical lesions in the majority of them, but their clinical impact still remains unknown. Cardiac involvement in SLE includes myo-pericarditis, valvular disease/endocarditis, Heart Failure (HF), coronary macro-microvascular disease, vasculitis and pulmonary hypertension. Classic and advanced Cardiovascular Magnetic Resonance (CMR) indices allow function and tissue characterization for early diagnosis and treatment follow-up of CVD in SLE. : Although currently, there are no clinical data supporting the combined use of brain/heart MRI in asymptomatic SLE, it may have a place in cases with clinical suspicion of brain/heart involvement, especially in patients at high risk for CVD/stroke such as SLE with antiphospholipid syndrome (SLE/APS), in whom concurrent cardiac and brain lesions have been identified. Furthermore, it may be of value in SLE with multi-organ involvement, NPSLE with concurrent cardiac involvement, and recent onset of arrhythmia and/or heart failure.

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Brain Magnetic Resonance Imaging in Newly Diagnosed Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.071010 ◽

2008 ◽

Vol 35 (12) ◽

pp. 2348-2354 ◽

Cited By ~ 58

Author(s):

MICHELLE PETRI ◽

MOHAMMAD NAQIBUDDIN ◽

KATHRYN A. CARSON ◽

DANIEL J. WALLACE ◽

MICHAEL H. WEISMAN ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Systemic Lupus Erythematosus ◽

African American ◽

Lupus Erythematosus ◽

Brain Magnetic Resonance Imaging ◽

Cerebral Atrophy ◽

Newly Diagnosed ◽

Resonance Imaging ◽

Systemic Lupus ◽

Focal Lesions

ObjectiveWe wished to determine the prevalence of cerebral atrophy and focal lesions in a cohort of patients with newly diagnosed systemic lupus erythematosus (SLE) and the association of these brain abnormalities with clinical characteristics.MethodsA total of 97 patients with SLE, within 9 months of diagnosis, with 4 or more American College of Rheumatology classification criteria, were enrolled. Brain magnetic resonance imaging was performed.ResultsThe patients were 97% female, mean age 38.1 (SD 12.2) years, education 15.1 (2.8) years; 59 Caucasian, 11 African American, 19 Hispanic, 5 Asian, and 3 other ethnicity. Cerebral atrophy was prevalent in 18% (95% CI 11%–27%): mild in 12%, moderate in 5%. Focal lesions were prevalent in 8% (95% CI 4%–16%): mild in 2%, moderate in 5%, severe in 1%. Patients with cerebral atrophy were more likely to have anxiety disorder (p = 0.04). Patients with focal lesions were more likely to be African American (p = 0.045) and had higher Safety of Estrogens in Lupus Erythematosus National Assessment SLEDAI scores (p = 0.02) and anti-dsDNA (p = 0.05).ConclusionIn this population with newly diagnosed SLE, brain abnormalities were prevalent in 25% of patients. These findings suggest that the brain may be affected extremely early in the course of SLE, even before the clinical diagnosis of SLE is made. Followup of these patients is planned, to determine the reversibility or progression of these abnormalities and their association with and potential predictive value for subsequent neuropsychiatric SLE manifestations.

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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

Rheumatology Practice and Research ◽

10.1177/2059902116663058 ◽

2017 ◽

Vol 2 ◽

pp. 205990211666305 ◽

Cited By ~ 1

Author(s):

Omed Amin ◽

Arvind Kaul ◽

Toby O Smith ◽

Franklyn A Howe ◽

Nidhi Sofat

Keyword(s):

Magnetic Resonance Imaging ◽

Systemic Lupus Erythematosus ◽

Magnetic Resonance ◽

Confidence Interval ◽

Risk Ratio ◽

Lupus Erythematosus ◽

Brain Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Systemic Lupus ◽

Neuropsychiatric Systemic Lupus Erythematosus

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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