Extended report
Sensitivity of quantitative 1H magnetic resonance
spectroscopy of the brain in detecting early neuronal damage in
systemic lupus erythematosus
J S Axforda, F A Howeb, C Heronc, J R Griffithsb
a Academic Unit for
Musculoskeletal Disease, St George's Hospital Medical School, Cranmer
Terrace, London SW17 0RE, UK, b CRC Biomedical Magnetic Research Group, St
George's Hospital Medical School, c MRI Unit, Radiology Department, St
George's Hospital, Blackshaw Road, London SW17 0QT, UK
Correspondence to: Dr Axford j.axford{at}sghms.ac.uk
Accepted for publication 7 June 2000
OBJECTIVE
To quantify
N-acetylaspartate (NAA), total creatines
(tCr), total cholines (tCho), and myo-inositol (mI) levels in normal and abnormal appearing white matter of patients with neuropsychiatric systemic lupus erythematosus (NPSLE) in order to determine the specific
changes in metabolite concentrations.
METHODSAxial proton
density and T2 weighted magnetic resonance images, and
short echo time (TE 30 ms) 1H spectra were acquired with a
GE SIGNA 1.5 T magnetic resonance system. Concentrations of NAA, tCr,
tCho, and mI were determined, using brain tissue water as a reference,
from nine patients (seven female, mean age 40.3 years, range 16-65)
with NPSLE and eight healthy women (mean age 43 years, range 31-65).
RESULTSA significant
rise of tCho (12.4%, p<0.05) and mI (31.4%, p<0.005) and a
significant reduction in NAA (
12%, p<0.05) was found in normal
appearing white matter compared with controls. Analysis according to
severity of the clinical NPSLE features (subgrouped as major or minor)
showed that SLE major had reduced NAA compared with SLE minor
(18.4%, p<0.05) and controls (20%, p<0.005). The SLE major
group showed a significant rise of mI (32%, p<0.01) and the SLE minor
group a significant increase in tCho (18.6%, p<0.05) compared with
controls. Longitudinal analysis of brain metabolites in normal
appearing white matter showed consistent abnormalities in NAA, tCho,
and mI in a patient with stable clinical features and a constant rise
of tCho, but transient rise of mI was seen during a flare of disease in
another patient.
CONCLUSIONQuantitative
1H magnetic resonance spectroscopy (MRS) suggests a
particular course of neurometabolite changes that precedes irreversible
reductions in NAA and permanent neuronal loss. Initially, in patients
with SLE minor, there is a significant rise in tCho and a trend
(reversible) for mI also to be raised. In patients with SLE major the
NAA is significantly and permanently reduced and mI is significantly
raised, whereas the tCho levels are near normal. Further investigations
are needed to determine how specific MRS is as a clinical marker for
brain disturbance in SLE.
© 2001 by Annals of the Rheumatic Diseases
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