Brain study using magnetic resonance imaging and proton MR spectroscopy in pediatric onset systemic lupus erythematosus.
OBJECTIVE
The aim of the present study was to assess and monitor brain damage in patients with pediatric onset systemic lupus erythematosus (SLE) using non-invasive techniques such as magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (H-MRS).


METHODS
Twenty-four SLE patients, both symptomatic or asymptomatic for central nervous system (CNS) involvement, and 20 controls were examined. Each individual underwent a diagnostic MRI using a 1.5 T Philips ACS-NT scanner including transverse T2-weighted (T2W) spin echo, transverse FLuid Attenuated Inversion Recovery (FLAIR), and sagittal T2W turbo spin echo 5 mm slices. In addition, single voxel proton MR spectroscopy localized on the supraventricular region was performed in all patients and controls. Patients were re-examined after one year.


RESULTS
75% of SLE patients had clinical CNS involvement; 46% showed abnormal MRI (3 of them, in the absence of neurologic signs); 4 SLE patients showed N-acetylaspartate/Creatine (NAA/Cr) ratios significantly lower than the controls. Among 5 SLE patients examined at the onset of the disease, 1 had MRI alterations and another showed a decrease of NAA/Cr values. Three patients with relapses showed a correlation between the course of the disease and the NAA/Cr ratios.


CONCLUSIONS
MRI and H-MRS are non-invasive techniques that might be useful, in some cases, in detecting CNS involvement in SLE patients and monitoring the disease course and efficacy of pharmacological treatment.
Mortilla
M
M
Department of Radiology, A. Meyer Children's Hospital, Florence, Italy. m.mortilla@ao-meyer.toscana.it
Ermini
M
M
Nistri
M
M
Dal Pozzo
G
G
Falcini
F
F
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D019412:Anatomy, Cross-Sectional; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D012720:Severity of Illness Index; D013256:Steroids; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D013256:Steroids; D006886:Hydroxychloroquine