Wu Chengli, Deng Kemei, Zhang Yu, Qin Yuhong, Wen Jing, Chen Bihong T, Jiang Muliang
First Affiliated Hospital of GuangXi Medical University, Nanning, China.
City of Hope National Medical Center, Duarte, CA, USA.
Neuroradiology. 2025 Jul;67(7):1715-1731. doi: 10.1007/s00234-025-03619-9. Epub 2025 Apr 28.
Cognitive dysfunction (CD) is a common manifestation of central nervous system involvement in patients with systemic lupus erythematosus (SLE). Patients with SLE may develop CD insidiously at an early stage of the disease, and the lack of a standardized diagnostic test poses a major challenge in prompt diagnosis and management of these patients. This review summaries the current application of various magnetic resonance imaging (MRI) techniques for patients with SLE complicated with CD, aiming to identify potential quantitative neuroimaging biomarkers for patients with SLE and CD.
We systematically searched several databases between January 2003 to December 2024. We screened retrospective and prospective studies based on search criteria keywords (including structural or functional MRI, cognitive function, lupus, and systemic lupus erythematosus) to identify peer-reviewed articles that reported advanced structural and functional MRI metrics and evaluated CD in human patients with SLE.
123 studies (19 Bold-MRI studies, 9 DTI studies, 2 ASL studies, 4 MTI studies, 5 machine learning, and 84 other studies) were identified. Neuroimaging findings show that patients with CD have abnormal manifestations in the limbic system, hippocampus, corpus callosum, and frontal cortex, and these manifestations are closely related to cognitive functions. The most commonly affected cognitive domains are memory, attention, and executive ability. Multimodal MRI, integrating structural, functional, and perfusion parameters, combined with machine learning, can effectively predict cognitive function.
Advanced MRI analysis can identify the abnormalities in the whole brain and local brain regions associated with CD in patients with SLE. The integration of machine learning and multimodal MRI offers new perspectives for early identification and mechanistic studies of CD in SLE patients. More studies are needed to identify potential neuroimaging biomarkers to facilitate early diagnosis, timely treatment, and accurate prognosis for SLE patients with CD.
认知功能障碍（CD）是系统性红斑狼疮（SLE）患者中枢神经系统受累的常见表现。SLE患者可能在疾病早期隐匿性地出现CD，且缺乏标准化诊断测试给这些患者的及时诊断和管理带来了重大挑战。本综述总结了各种磁共振成像（MRI）技术在SLE合并CD患者中的当前应用，旨在为SLE和CD患者识别潜在的定量神经影像学生物标志物。
我们在2003年1月至2024年12月期间系统检索了多个数据库。我们根据检索标准关键词（包括结构或功能MRI、认知功能、狼疮和系统性红斑狼疮）筛选回顾性和前瞻性研究，以识别报告先进结构和功能MRI指标并评估SLE人类患者CD的同行评审文章。
共识别出123项研究（19项Bold-MRI研究、9项DTI研究、2项ASL研究、4项MTI研究、5项机器学习研究和84项其他研究）。神经影像学结果表明，CD患者在边缘系统、海马体、胼胝体和额叶皮质存在异常表现，且这些表现与认知功能密切相关。最常受影响的认知领域是记忆、注意力和执行能力。整合结构、功能和灌注参数的多模态MRI结合机器学习能够有效预测认知功能。
先进的MRI分析可以识别SLE患者中与CD相关的全脑和局部脑区异常。机器学习与多模态MRI的整合为SLE患者CD的早期识别和机制研究提供了新的视角。需要更多研究来识别潜在的神经影像学生物标志物，以促进SLE合并CD患者的早期诊断、及时治疗和准确预后。
