Evidence of central nervous system damage in patients with neuropsychiatric systemic lupus erythematosus, demonstrated by magnetization transfer imaging

Objective. The clinical symptoms of neuropsychiatric systemic lupus erythem atosus (NPSLE) are usually reversible, but whether the associated brain dam age is also reversible is still a matter of debate. Since magnetization tra nsfer imaging (MTI) is more sensitive than conventional magnetic resonance imaging (MRI) in demonstrating brain damage, it has become a useful tool in the detection and quantification of diffuse brain disorders such as multip le sclerosis, In this study, MTI was applied to investigate whether central nervous system (CNS) damage is present in patients,vith a history of NPSLE . Methods. Eleven female patients with a history of NPSLE and no previous or concurrent primary neurologic or psychiatric disease (ages 17-49 years), 11 female patients with SLE without a history of NPSLE (non-NPSLE; ages 15-51 years), and 10 healthy female controls (ages 17-47 years) underwent MTI, F rom these MTI scans, quantitative data on the uniformity of the brain paren chyma and atrophy were derived. Results. One NPSLE and 1 non-NPSLE patient were excluded from this study du e to infarctions detected mith conventional MRI, MTI measures normalized fo r intracranial volume, reflecting abnormalities of the brain parenchyma as well as atrophy, were lower (P < 0.001) in the NPSLE group than in both con trol groups. A higher (P < 0.005) mean ratio of cerebrospinal fluid to intr acranial volume, indicative of atrophy, was present in the NPSLE group comp ared with either the non-NPSLE patients or healthy controls. Still, the MTI measures solely reflecting uniformity of the brain parenchyma (normalized for brain volume) were also significantly (P < 0.001) lower in the NPSLE pa tients than in both control groups. Conclusion. This study demonstrates that using MTI, CNS damage can be demon strated in patients with a history of NPSLE. MTI might, therefore, be an al ternative and sensitive tool to detect brain injury in NPSLE, and might als o be useful in studying the natural history of the disease.