Tong Xinyu, He Huilin, Xu Shihan, Shen Rui, Ning Zihan, Zeng Xiaofeng, Wang Qian, He Zuo-Xiang, Xu Dong, Zhao Xihai
Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China.
Rheumatology (Oxford). 2024 Dec 1;63(12):3263-3270. doi: 10.1093/rheumatology/keae404.
The characteristics of brain impairment in different subtypes of systemic sclerosis (SSc) (dcSSc, diffuse cutaneous SSc; lcSSc, limited cutaneous SSc) remain unclear. This study aimed to characterize cerebral structure and perfusion changes in different subtypes of SSc patients using magnetic resonance (MR) imaging.
Seventy SSc patients (46.0 ± 11.7 years, 62 females) and 30 healthy volunteers (44.8 ± 13.7 years, 24 females) were recruited and underwent brain MR imaging and Montreal Cognitive Assessment (MoCA) test. Gray matter (GM) volumes were measured using voxel-based morphometry analysis on T1-weighted images. Voxel-based and regional cerebral blood flow (CBF) was calculated on arterial spin labelling images. The cerebral structural and perfusion measurements by MR imaging were compared among dcSSc, lcSSc and healthy subjects using one-way ANOVA. The correlations between clinical characteristics and MR imaging measurements were also analysed.
The dcSSc patients exhibited a significant reduction in GM volume in the para-hippocampal region (cluster P < 0.01, FWE corrected) compared with healthy volunteers. Whereas SSc patients, particularly lcSSc patients, showed elevated CBF in cerebellum, insula, cerebral cortex and subcortical structures (regional analyses: all P < 0.05; voxel-based analyses: cluster P < 0.01, FWE corrected). Furthermore, clinical characteristics of modified Rodnan skin score (mRSS) (r value ranged from -0.29 to -0.45), MoCA scores (r = 0.40) and anti-nuclear antibody (ANA) positivity (r = -0.33) were significantly associated with CBF in some regions (all P < 0.05).
The manifestations of brain involvement vary among different subtypes of SSc. In addition, severe skin sclerosis may indicate higher risk of brain involvement in SSc patients.
系统性硬化症（SSc）不同亚型（弥漫性皮肤型SSc，dcSSc；局限性皮肤型SSc，lcSSc）的脑损伤特征尚不清楚。本研究旨在利用磁共振（MR）成像来描述SSc患者不同亚型的脑结构和灌注变化。
招募了70例SSc患者（46.0±11.7岁，62例女性）和30名健康志愿者（44.8±13.7岁，24例女性），并对其进行脑MR成像和蒙特利尔认知评估（MoCA）测试。在T1加权图像上使用基于体素的形态学分析来测量灰质（GM）体积。在动脉自旋标记图像上计算基于体素和区域的脑血流量（CBF）。使用单因素方差分析比较dcSSc、lcSSc和健康受试者通过MR成像进行的脑结构和灌注测量。还分析了临床特征与MR成像测量之间的相关性。
与健康志愿者相比，dcSSc患者海马旁区域的GM体积显著减少（聚类P<0.01，FWE校正）。而SSc患者，尤其是lcSSc患者，在小脑、岛叶、大脑皮层和皮层下结构中显示出CBF升高（区域分析：均P<0.05；基于体素的分析：聚类P<0.01，FWE校正）。此外，改良Rodnan皮肤评分（mRSS）（r值范围为-0.29至-0.45）、MoCA评分（r=0.40）和抗核抗体（ANA）阳性（r=-0.33）的临床特征与某些区域的CBF显著相关（均P<0.05）。
SSc不同亚型的脑受累表现各不相同。此外，严重的皮肤硬化可能表明SSc患者脑受累的风险更高。
