Relationship Between Clinical and Immunological Features with Magnetic Resonance Imaging Abnormalities in Female Patients with Neuropsychiatric Systemic Lupus Erythematosus

Abstract

Background: Conventional magnetic resonance imaging (MRI) is the preferred neuroimaging method in the evaluation of neuropsychiatric systemic lupus erythematosus (NPSLE). The purpose of this study was to investigate the association between clinical and immunological features with MRI abnormalities in female patients with NPSLE, to screen for the value of conventional MRI in NPSLE.

Methods: A total of 59 female NPSLE patients with conventional MRI examinations were enrolled in this retrospective study. All patients were classified into different groups according to MRI abnormalities. Both clinical and immunological features were compared between MRI abnormal and normal groups. One-way analysis of variance was used to compare the systemic lupus erythematosus disease activity index (SLEDAI) score for MRI abnormalities. Multivariate logistic regression analysis investigated the correlation between immunological features, neuropsychiatric manifestations, and MRI abnormalities.

Results: Thirty-six NPSLE patients (61%) showed a variety of MRI abnormalities. There were statistically significant differences in SLEDAI scores (P < 0.001), incidence of neurologic disorders (P = 0.001), levels of 24-h proteinuria (P = 0.001) and immunoglobulin M (P = 0.004), and incidence of acute confusional state (P = 0.002), cerebrovascular disease (P = 0.004), and seizure disorder (P = 0.028) between MRI abnormal and normal groups. In the MRI abnormal group, SLEDAI scores for cerebral atrophy (CA), cortex involvement, and restricted diffusion (RD) were much higher than in the MRI normal group (P < 0.001, P = 0.002, P = 0.038, respectively). Statistically significant positive correlations between seizure disorder and cortex involvement (odds ratio [OR] = 14.90; 95% confidence interval [CI], 1.50-151.70; P = 0.023) and cerebrovascular disease and infratentorial involvement (OR = 10.00; 95% CI, 1.70-60.00; P = 0.012) were found.

Conclusions: MRI abnormalities in NPSLE, especially CA, cortex involvement, and RD might be markers of high systemic lupus erythematosus activity. Some MRI abnormalities might correspond to neuropsychiatric manifestations and might be helpful in understanding the pathophysiology of NPSLE.

Figure 1

Diffuse BG involvement in a patient with active NPSLE, showing diffuse BG hypointensity on the T1-weighted images, (a) and increased signal intensity on the FLAIR images, (b) in an 11-year-old girl. Focal left lenticular nucleus high signal on DWI (b = 1000) (c) and low signal on the ADC map (d) were found, which indicated cytotoxic edema. In addition, white matter in the bilateral cerebral peduncles, temporal lobe, and centrum semiovale also was involved (not shown). The patient was hospitalized due to blunting of mood and affect and hydrosarca for 3 h and was diagnosed with active NPSLE. The SLEDAI score of this patient was 34. BG: Basal ganglia; NPSLE: Neuropsychiatric systemic lupus erythematosus; FLAIR: Fluid-attenuated inversion recovery; DWI: Diffusion weighted imaging; ADC: Apparent diffusion coefficient; SLEDAI: Systemic lupus erythematosus disease activity index.

Figure 2

The SLEDAI scores of different MRI abnormalities. The SLEDAI scores of CA (34.0 ± 13.2), cortex involvement (33.2 ± 7.6), restricted diffusion (32.5 ± 10.5), IT involvement (30.8 ± 9.7), and SWM involvement (29.8 ± 10.3) were higher than NC (P < 0.001, P = 0.002, P = 0.038, P = 0.028, P = 0.004). No significantly statistical difference was found between differences in MRI abnormalities. SLEDAI: Systemic lupus erythematosus disease activity index; MRI: Magnetic resonance imaging; NC: Normal control; PVWM: Periventricular white matter; BG: Basal ganglia; SWM: Subcortical white matter; IT: Infratentorial; RD: Restricted diffusion; CA: Cerebral atrophy.