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Neuropsychiatric lupus or not? Cerebral hypoperfusion by perfusion-weighted MRI in normal-appearing white matter in primary neuropsychiatric lupus erythematosus
  1. Efrosini Papadaki1,2,
  2. Antonis Fanouriakis3,4,
  3. Eleftherios Kavroulakis1,
  4. Dimitra Karageorgou1,
  5. Prodromos Sidiropoulos3,
  6. George Bertsias3,5,
  7. Panagiotis Simos2,6,
  8. Dimitrios T Boumpas4,5,7,8,9
  1. 1 Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, Heraklion, Greece
  2. 2 Institute of Computer Science, Foundation of Research and Technology, Heraklion, Greece
  3. 3 Department of Rheumatology, Clinical Immunology and Allergy, School of Medicine, University of Crete, University Hospital of Heraklion, Heraklion, Greece
  4. 4 Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodestrian University of Athens, Athens, Greece
  5. 5 Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology-Hellas, Heraklion, Greece
  6. 6 Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Heraklion, Greece
  7. 7 Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
  8. 8 Joint Academic Rheumatology Program, Medical School, National and Kapodestrian University of Athens, Athens, Greece
  9. 9 Medical School, University of Cyprus, Nicosia, Cyprus
  1. Correspondence to Ass. Professor Efrosini Papadaki, Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, Heraklion 71306, Greece; fpapada{at}otenet.gr

Abstract

Objectives Cerebral perfusion abnormalities have been reported in systemic lupus erythematosus (SLE) but their value in distinguishing lupus from non-lupus-related neuropsychiatric events remains elusive. We examined whether dynamic susceptibility contrast-enhanced perfusion MRI (DSC-MRI), a minimally invasive and widely available method of cerebral perfusion assessment, may assist neuropsychiatric SLE (NPSLE) diagnosis.

Methods In total, 76patients with SLE (37 primary NPSLE, 16 secondary NPSLE, 23 non-NPSLE) and 31 healthy controls underwent conventional MRI (cMRI) and DSC-MRI. Attribution of NPSLE to lupus or not was based on multidisciplinary assessment including cMRI results and response to treatment. Cerebral blood volume and flow were estimated in 18 normal-appearing white and deep grey matter areas.

Results The most common manifestations were mood disorder, cognitive disorder and headache. Patients with primary NPSLE had lower cerebral blood flow and volume in several normal-appearing white matter areas compared with controls (P<0.0001) and lower cerebral blood flow in the semioval centre bilaterally, compared with non-NPSLE and patients with secondary NPSLE (P<0.001). A cut-off for cerebral blood flow of 0.77 in the left semioval centre discriminated primary NPSLE from non-NPSLE/secondary NPSLE with 80% sensitivity and 67%–69% specificity. Blood flow values in the left semioval centre showed substantially higher sensitivity than cMRI (81% vs 19%–24%) for diagnosing primary NPSLE with the combination of the two modalities yielding 94%–100% specificity in discriminating primary from secondary NPSLE.

Conclusion Primary NPSLE is characterised by significant hypoperfusion in cerebral white matter that appears normal on cMRI. The combination of DSC-MRI-measured blood flow in the brain semioval centre with conventional MRI may improve NPSLE diagnosis.

  • magnetic resonance imaging
  • systemic lupus erythematosus
  • disease activity

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Footnotes

  • AF and EK contributed equally.

  • Handling editor Tore K Kvien

  • Contributors EP designed the study, performed and interpreted the MRI exams, analysed the MR perfusion data, wrote, edited and critically reviewed the manuscript. AF performed clinical examination of patients, edited the manuscript. EK collected image data and performed image analysis. DK performed image analysis. PS performed clinical examination of patients. GB performed clinical examination of patients, edited and critically reviewed the manuscript. PS performed neuropsychological assessment and statistical analysis, edited and critically reviewed the manuscript. DTB designed the study, performed clinical examination of patients, edited and critically reviewed the manuscript. All authors contributed substantially to discussion of content.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval University Hospital of Heraklion Ethical Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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