Leiden University Medical Center, Leiden, The Netherlands.
C. J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands.
Arthritis Rheumatol. 2016 Aug;68(8):1945-54. doi: 10.1002/art.39653.
To assess white matter (WM) and gray matter (GM) magnetization transfer ratio histogram peak heights (MTR-HPHs) in different subsets of patients with neuropsychiatric systemic lupus erythematosus (NPSLE) who have unremarkable findings on 3T magnetic resonance imaging of the brain and to evaluate whether these values could be used to highlight different clinically suspected underlying pathogenic processes or identify the clinical NPSLE status or whether they could be associated with a specific NPSLE syndrome.
Sixty-four SLE patients with neuropsychiatric symptoms were included. The initial NPSLE diagnosis and suspected underlying pathogenic process were established by multidisciplinary evaluation. The final diagnosis was made after also considering the disease course 6-18 months later. Thirty-three patients with central nervous system (CNS) NPSLE and 31 SLE patients with neuropsychiatric symptoms unrelated to SLE (non-SLE-related NP) were included. Twenty SLE patients without neuropsychiatric symptoms and 36 healthy control subjects were included for comparison. Differences in the WM and GM mean MTR-HPHs and between the different NPSLE subgroups (CNS NPSLE diagnosis, NPSLE phenotype [inflammatory or ischemic], and clinical changes after treatment) and the relationship to NPSLE syndromes were evaluated.
Patients with inflammatory NPSLE had significantly lower WM MTR-HPHs than did the healthy controls, the SLE patients, and the non-SLE-related NP patients. Cognitive disorder, mood disorder, and psychosis were related to lower WM MTR-HPH values and cerebrovascular symptoms to higher values. Furthermore, the mean MTR-HPHs in the WM increased when the clinical status of the NPSLE patients improved.
Measurement of MTR-HPH of the WM has the potential to identify inflammatory NPSLE with CNS involvement. This finding underscores the usefulness of this technique for the detection of cerebral changes in NPSLE patients and for the assessment of clinical changes after treatment.
评估在 3T 磁共振脑成像无明显异常的神经精神性系统性红斑狼疮（NPSLE）患者的不同亚组的脑白质（WM）和灰质（GM）磁化转移率直方图峰高（MTR-HPH），并评估这些值是否可用于突出不同的潜在致病过程，或识别临床 NPSLE 状态，或与特定的 NPSLE 综合征相关。
纳入 64 例有神经精神症状的 SLE 患者。通过多学科评估确定初始 NPSLE 诊断和疑似潜在致病过程。根据 6-18 个月后的疾病进程，最终确定诊断。共纳入 33 例中枢神经系统（CNS）NPSLE 患者和 31 例与 SLE 无关的神经精神症状（非-SLE 相关 NP）患者。纳入 20 例无神经精神症状的 SLE 患者和 36 例健康对照者进行比较。评估 WM 和 GM 平均 MTR-HPH 之间的差异，以及不同 NPSLE 亚组（CNS NPSLE 诊断、NPSLE 表型[炎症或缺血]以及治疗后临床变化）之间的差异，并与 NPSLE 综合征的关系。
炎症性 NPSLE 患者 WM MTR-HPH 明显低于健康对照组、SLE 患者和非-SLE 相关 NP 患者。认知障碍、情绪障碍和精神病与 WM MTR-HPH 值降低相关，而脑血管症状与 MTR-HPH 值升高相关。此外，NPSLE 患者的临床状况改善时，WM 的平均 MTR-HPH 值升高。
WM 的 MTR-HPH 测量有潜力识别有 CNS 受累的炎症性 NPSLE。这一发现强调了该技术在检测 NPSLE 患者脑变化和评估治疗后临床变化方面的有效性。
