Bosma G P, Rood M J, Zwinderman A H, Huizinga T W, van Buchem M A
Leiden University Medical Center, The Netherlands.
Arthritis Rheum. 2000 Jan;43(1):48-54. doi: 10.1002/1529-0131(200001)43:1<48::AID-ANR7>3.0.CO;2-H.
The clinical symptoms of neuropsychiatric systemic lupus erythematosus (NPSLE) are usually reversible, but whether the associated brain damage is also reversible is still a matter of debate. Since magnetization transfer 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 multiple sclerosis. In this study, MTI was applied to investigate whether central nervous system (CNS) damage is present in patients with a history of NPSLE.
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. From these MTI scans, quantitative data on the uniformity of the brain parenchyma and atrophy were derived.
One NPSLE and 1 non-NPSLE patient were excluded from this study due to infarctions detected with conventional MRI. MTI measures normalized for intracranial volume, reflecting abnormalities of the brain parenchyma as well as atrophy, were lower (P < 0.001) in the NPSLE group than in both control groups. A higher (P < 0.005) mean ratio of cerebrospinal fluid to intracranial volume, indicative of atrophy, was present in the NPSLE group compared 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 patients than in both control groups.
This study demonstrates that using MTI, CNS damage can be demonstrated in patients with a history of NPSLE. MTI might, therefore, be an alternative and sensitive tool to detect brain injury in NPSLE, and might also be useful in studying the natural history of the disease.
神经精神性系统性红斑狼疮（NPSLE）的临床症状通常是可逆的，但与之相关的脑损伤是否也可逆仍存在争议。由于磁化传递成像（MTI）在显示脑损伤方面比传统磁共振成像（MRI）更敏感，它已成为检测和量化诸如多发性硬化等弥漫性脑部疾病的有用工具。在本研究中，应用MTI来调查有NPSLE病史的患者是否存在中枢神经系统（CNS）损伤。
11名有NPSLE病史且既往无原发性神经或精神疾病且无并发此类疾病的女性患者（年龄17 - 49岁）、11名无NPSLE病史的SLE女性患者（非NPSLE；年龄15 - 51岁）和10名健康女性对照者（年龄17 - 47岁）接受了MTI检查。从这些MTI扫描中，得出关于脑实质均匀性和萎缩的定量数据。
由于传统MRI检测到梗死，1名NPSLE患者和1名非NPSLE患者被排除在本研究之外。针对颅内体积进行标准化的MTI测量值，反映脑实质异常以及萎缩情况，NPSLE组低于两个对照组（P < 0.001）。与非NPSLE患者或健康对照者相比，NPSLE组脑脊液与颅内体积的平均比值更高（P < 0.005），表明存在萎缩。然而，仅反映脑实质均匀性（针对脑体积进行标准化）的MTI测量值在NPSLE患者中也显著低于两个对照组（P < 0.001）。
本研究表明，使用MTI可在有NPSLE病史的患者中显示CNS损伤。因此，MTI可能是检测NPSLE脑损伤的一种替代性敏感工具，也可能有助于研究该疾病的自然病程。
