Evidence of central nervous system damage in patients with neuropsychiatric systemic lupus erythematosus, demonstrated by magnetization transfer imaging
Gpt. Bosma et al., Evidence of central nervous system damage in patients with neuropsychiatric systemic lupus erythematosus, demonstrated by magnetization transfer imaging, ARTH RHEUM, 43(1), 2000, pp. 48-54
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.