对比增强血管壁磁共振成像对神经精神性系统性红斑狼疮的诊断价值
The Diagnostic Value of Contrast-Enhanced Vessel Wall MRI for Diagnosing Neuropsychiatric Systemic Lupus Erythematosus.
作者信息
Ide Satoru, Fujita Yuya, Murakami Yu, Futatsuya Koichiro, Yoshimatsu Yuta, Tsukamoto Jun, Oku Haruka, Sakamoto Toshihiro, Tanaka Yoshiya, Aoki Takatoshi
机构信息
Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
The First Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
出版信息
J Magn Reson Imaging. 2025 Oct;62(4):1021-1034. doi: 10.1002/jmri.29810. Epub 2025 May 13.
BACKGROUND
Imaging biomarkers for neuropsychiatric systemic lupus erythematosus (NPSLE) are highly needed, and intracranial contrast-enhanced vessel wall imaging (CE-VWI) can potentially detect cerebral vessel wall abnormalities in lupus.
PURPOSE
To evaluate the diagnostic value of CE-VWI in differentiating NPSLE from non-NPSLE.
STUDY TYPE
Cross-sectional, retrospective.
SUBJECTS
Forty-seven patients with NPSLE (mean age, 44.3 years ± 13.2 standard deviation [SD], 40 females, 85%) and 52 patients without NPSLE (mean age, 43.0 years ± 16.5 SD, 49 females, 89%). The non-NPSLE group consisted of SLE patients who had no NP symptoms or were diagnosed with comorbidities from other diseases.
FIELD STRENGTH/SEQUENCE: 3-T, three-dimensional (3D) contrast-enhanced vessel wall imaging (3D-T1-CUBE).
ASSESSMENT
Vessel wall lesions (VWLs) were visually assessed across 15 segments, from the internal carotid artery and basilar artery to A1-A2 for ACA, M1-M2 for MCA, and P1-P2 for PCA, for wall thickening and enhancement. Conventional MRI and MR angiography were also used to assess infarction, hemorrhage, atrophy, and arterial stenosis.
STATISTICAL TESTS
Paired comparisons using the chi-square and unpaired t-tests were followed by multivariate logistic regression analysis incorporating factors with significant group differences to identify associations with NPSLE. Receiver operating characteristic (ROC) analysis with the area under the curve (AUC) assessed the diagnostic performance of CE-VWI. A p-value < 0.05 was considered statistically significant.
RESULTS
The NPSLE group showed a significantly higher number of contrast-enhancing VWLs (CE-VWLs; median [interquartile range]: 2 [0.5-4] vs. 0 [0-1]). Cerebral infarctions and arterial stenotic lesions were more common in NPSLE, occurring in 12 (26%) vs. 2 (3%) and 19 (40%) vs. 5 (9%) of patients, respectively. A multivariate logistic regression analysis identified CE-VWLs as the sole significant factor associated with NPSLE (odds ratio, 1.97; 95% confidence interval, 1.23-3.16). The ROC analysis showed an AUC of 0.78 for CE-VWLs, with a sensitivity of 60% and a specificity of 87%.
DATA CONCLUSION
CE-VWI may demonstrate high specificity and good diagnostic performance in differentiating NPSLE from non-NPSLE.
EVIDENCE LEVEL
TECHNICAL EFFICACY
Stage 2.
背景
神经精神性系统性红斑狼疮（NPSLE）的影像学生物标志物非常必要，颅内对比增强血管壁成像（CE-VWI）有可能检测狼疮患者的脑血管壁异常。
目的
评估CE-VWI在鉴别NPSLE与非NPSLE中的诊断价值。
研究类型
横断面、回顾性研究。
研究对象
47例NPSLE患者（平均年龄44.3岁±13.2标准差[SD]，40例女性，占85%）和52例非NPSLE患者（平均年龄43.0岁±16.5 SD，49例女性，占89%）。非NPSLE组包括无NP症状或被诊断患有其他疾病合并症的SLE患者。
场强/序列：3-T，三维（3D）对比增强血管壁成像（3D-T1-CUBE）。
评估
从颈内动脉和基底动脉到大脑前动脉的A1-A2段、大脑中动脉的M1-M2段以及大脑后动脉的P1-P2段，对15个节段的血管壁病变（VWLs）进行视觉评估，观察壁增厚和强化情况。还使用传统MRI和MR血管造影评估梗死、出血、萎缩和动脉狭窄。
统计检验
采用卡方检验和非配对t检验进行配对比较，然后进行多因素逻辑回归分析，纳入具有显著组间差异的因素，以确定与NPSLE的关联。采用曲线下面积（AUC）的受试者操作特征（ROC）分析评估CE-VWI的诊断性能。p值<0.05被认为具有统计学意义。
结果
NPSLE组对比增强VWLs（CE-VWLs）的数量显著更高（中位数[四分位间距]：2[0.5-4]对0[0-1]）。脑梗死和动脉狭窄性病变在NPSLE中更常见，分别发生在12例（26%）对2例（3%）患者以及19例（40%）对5例（9%）患者中。多因素逻辑回归分析确定CE-VWLs是与NPSLE相关的唯一显著因素（优势比，1.97；95%置信区间，1.23-3.16）。ROC分析显示CE-VWLs的AUC为0.78，敏感性为60%，特异性为87%。
数据结论
CE-VWI在鉴别NPSLE与非NPSLE方面可能具有高特异性和良好的诊断性能。
证据水平
3级。
技术效能
2级。
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