Background Neurological manifestations in systemic lupus erythematosus (SLE) are diverse. Because of its varied manifestations and low prevalence, the ACR has developed nomenclature and case definitions for neuropsychiatric SLE (NPSLE) to facilitate clinical research. Brain MRI has been used for the evaluation of neurologic symptoms.
Objectives The purpose of this study was to identify characteristic brain MRI findings in NPSLE and to investigate the association between brain MRI findings and NPSLE manifestations.
Methods In total, 145 brain MRIs in 126 patients with NPSLE from 2002 to 2013 from three tertiary university hospitals were retrospectively reviewed. The images were evaluated for the presence of white matter hyperintensity (WMH), gray matter hyperintensity (GMH), parenchymal defects, atrophy, enhancement, and the abnormalities in diffusion-weighted image (DWI). The number, size and location of WMH,GMH and parenchymal defects were evaluated. The NPSLE manifestations of each patient were classified according to the 1999 ACR case definitions for NPSLE syndromes. The associations between MRI findings and manifestations of NPSLE were examined.
Results In total, 103 MRIs (71.0%) exhibited abnormalities among the 145 MRIs reviewed. There were 172 NP events that encompassed 16 of 19 NP syndromes. The most common MRI abnormalities were WMHs. One or more WMHs were found in 84 MRIs (57.9%) among the total 145 MRIs. GMHs were observed in 42 MRIs (29.0%). GMHs tended to involve much larger areas than WMHs. Patients with cerebrovascular disease or seizures were more likely to have GMHs than patients with other NP manifestations. 33 MRIs among 42 MRIs which had GMHs also exhibited WMHs. Parenchymal defects were found in 35 MRIs (24.1%). Atrophy was detected in 26 MRIs (17.9%). Brain MRIs were enhanced in 21 of the 126 cases that had undergone enhancement. Patients who had seizures were more likely to demonstrate MRI enhancement than patients with other NP manifestations. DWIs were obtained in 102 MRIs and abnormal DWIs were obtained in 18 MRIs cases. Patients with cerebrovascular disease were more likely to have GMH, parenchymal defects and abnormal DWI than patients with other NP manifestations
Conclusions Diverse brain MRI abnormalities were observed in the brain MRI of patients with NPSLE. In addition to WMHs, which were previously known as SLE findings, we also noted the presence of GMHs, parenchymal defects and abnormal DWI in a substantial portion of SLE patients, particularly in those with cerebrovascular disease or seizure.
Disclosure of Interest None declared