title: Evidence of central nervous system damage in patients with neuropsychiatric systemic lupus erythematosus, demonstrated by magnetization transfer imaging.
abstract: OBJECTIVE
  The clinical symptoms of neuropsychiatric systemic lupus erythematosus (NPSLE) are usually reversible, but whether the associated brain damage is also reversible is still a matter of debate. Since magnetization transfer imaging (MTI) is more sensitive than conventional magnetic resonance imaging (MRI) in demonstrating brain damage, it has become a useful tool in the detection and quantification of diffuse brain disorders such as multiple sclerosis. In this study, MTI was applied to investigate whether central nervous system (CNS) damage is present in patients with a history of NPSLE.
  
  
  METHODS
  Eleven female patients with a history of NPSLE and no previous or concurrent primary neurologic or psychiatric disease (ages 17-49 years), 11 female patients with SLE without a history of NPSLE (non-NPSLE; ages 15-51 years), and 10 healthy female controls (ages 17-47 years) underwent MTI. From these MTI scans, quantitative data on the uniformity of the brain parenchyma and atrophy were derived.
  
  
  RESULTS
  One NPSLE and 1 non-NPSLE patient were excluded from this study due to infarctions detected with conventional MRI. MTI measures normalized for intracranial volume, reflecting abnormalities of the brain parenchyma as well as atrophy, were lower (P < 0.001) in the NPSLE group than in both control groups. A higher (P < 0.005) mean ratio of cerebrospinal fluid to intracranial volume, indicative of atrophy, was present in the NPSLE group compared with either the non-NPSLE patients or healthy controls. Still, the MTI measures solely reflecting uniformity of the brain parenchyma (normalized for brain volume) were also significantly (P < 0.001) lower in the NPSLE patients than in both control groups.
  
  
  CONCLUSIONS
  This study demonstrates that using MTI, CNS damage can be demonstrated in patients with a history of NPSLE. MTI might, therefore, be an alternative and sensitive tool to detect brain injury in NPSLE, and might also be useful in studying the natural history of the disease.
authors.affiliation: Leiden University Medical Center, The Netherlands.
authors.forename: G P
authors.initials: GP
authors.lastname: Bosma
authors.forename: M J
authors.initials: MJ
authors.lastname: Rood
authors.forename: A H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: T W
authors.initials: TW
authors.lastname: Huizinga
authors.forename: M A
authors.initials: MA
authors.lastname: van Buchem
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008280:Magnetics; D008875:Middle Aged; D012680:Sensitivity and Specificity