Department of Clinical Sciences/Radiology, Lund University, Lund, Sweden.
Department of Clinical Sciences/Radiology, Lund University, Lund, Sweden; Department of Clinical Sciences/Division of Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden.
Neuroimage Clin. 2023;38:103390. doi: 10.1016/j.nicl.2023.103390. Epub 2023 Mar 28.
Dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) has previously shown alterations in cerebral perfusion in patients with systemic lupus erythematosus (SLE). However, the results have been inconsistent, in particular regarding neuropsychiatric (NP) SLE. Thus, we investigated perfusion-based measures in different brain regions in SLE patients with and without NP involvement, and additionally, in white matter hyperintensities (WMHs), the most common MRI pathology in SLE patients.
We included 3 T MRI images (conventional and DSC) from 64 female SLE patients and 19 healthy controls (HC). Three different NPSLE attribution models were used: the Systemic Lupus International Collaborating Clinics (SLICC) A model (13 patients), the SLICC B model (19 patients), and the American College of Rheumatology (ACR) case definitions for NPSLE (38 patients). Normalized cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were calculated in 26 manually drawn regions of interest and compared between SLE patients and HC, and between NPSLE and non-NPSLE patients. Additionally, normalized CBF, CBV and MTT, as well as absolute values of the blood-brain barrier leakage parameter (K) were investigated in WMHs compared to normal appearing white matter (NAWM) in the SLE patients.
After correction for multiple comparisons, the most prevalent finding was a bilateral significant decrease in MTT in SLE patients compared to HC in the hypothalamus, putamen, right posterior thalamus and right anterior insula. Significant decreases in SLE compared to HC were also found for CBF in the pons, and for CBV in the bilateral putamen and posterior thalamus. Significant increases were found for CBF in the posterior corpus callosum and for CBV in the anterior corpus callosum. Similar patterns were found for both NPSLE and non-NPSLE patients for all attributional models compared to HC. However, no significant perfusion differences were revealed between NPSLE and non-NPSLE patients regardless of attribution model. The WMHs in SLE patients showed a significant increase in all perfusion-based metrics (CBF, CBV, MTT and K) compared to NAWM.
Our study revealed perfusion differences in several brain regions in SLE patients compared to HC, independently of NP involvement. Furthermore, increased K in WMHs compared to NAWM may indicate blood-brain barrier dysfunction in SLE patients. We conclude that our results show a robust cerebral perfusion, independent from the different NP attribution models, and provide insight into potential BBB dysfunction and altered vascular properties of WMHs in female SLE patients. Despite SLE being most prevalent in females, a generalization of our conclusions should be avoided, and future studies including all sexes are needed.
动态磁敏感对比（DSC）磁共振成像（MRI）先前已显示系统性红斑狼疮（SLE）患者的脑灌注改变。然而，结果一直不一致，特别是在神经精神性（NP）SLE 方面。因此，我们研究了 SLE 患者中存在和不存在 NP 受累的不同脑区的基于灌注的指标，此外，还研究了 SLE 患者中最常见的 MRI 病理改变——脑白质高信号（WMH）。
我们纳入了 64 名女性 SLE 患者和 19 名健康对照者（HC）的 3T MRI 图像（常规和 DSC）。使用了三种不同的 NPSLE 归因模型：SLE 国际协作临床（SLICC）A 模型（13 名患者）、SLICC B 模型（19 名患者）和美国风湿病学会（ACR）NPSLE 病例定义（38 名患者）。在 26 个手动绘制的感兴趣区域中计算了归一化脑血流量（CBF）、脑血容量（CBV）和平均通过时间（MTT），并将 SLE 患者与 HC 进行了比较，还将 NPSLE 患者与非 NPSLE 患者进行了比较。此外，在 SLE 患者的 WMH 中还比较了归一化 CBF、CBV 和 MTT 以及血脑屏障通透性参数（K）的绝对值与正常外观白质（NAWM）。
经多次比较校正后，最常见的发现是与 HC 相比，SLE 患者的下丘脑、壳核、右侧丘脑后和右侧前岛叶双侧 MTT 显著降低。与 HC 相比，SLE 患者的脑桥 CBF 和双侧壳核 CBV 也显著降低。SLE 患者的后胼胝体 CBF 和前胼胝体 CBV 显著增加。对于所有归因模型，与 HC 相比，无论是 NPSLE 还是非 NPSLE 患者，都表现出相似的 CBF 和 CBV 模式。然而，无论采用何种归因模型，NPSLE 患者与非 NPSLE 患者之间的灌注差异均无统计学意义。SLE 患者的 WMH 与 NAWM 相比，所有基于灌注的指标（CBF、CBV、MTT 和 K）均显著增加。
我们的研究显示，与 HC 相比，SLE 患者的几个脑区存在灌注差异，与 NP 受累无关。此外，与 NAWM 相比，WMH 中的 K 值增加可能表明 SLE 患者的血脑屏障功能障碍。我们得出结论，我们的结果显示出与不同的 NP 归因模型无关的稳健脑灌注，并为女性 SLE 患者的潜在 BBB 功能障碍和 WMH 血管特性改变提供了见解。尽管 SLE 在女性中更为普遍，但应避免推广我们的结论，还需要包括所有性别的未来研究。
