title: Advanced magnetic resonance imaging of the brain in patients treated with TNF-alpha blocking agents.
abstract: OBJECTIVE
  Neurological symptoms have been reported in patients treated with anti-TNF-alpha. In a pilot study we evaluated the effect of anti-TNF-alpha on cerebral parenchyma using advanced Magnetic Resonance (MR) techniques.
  
  
  METHODS
  Seven patients with a systemic inflammatory disease (5 rheumatoid arthritis, 2 psoriatic arthritis) had Magnetization Transfer Imaging, Diffusion Weighted Imaging (DWI) and Magnetic Resonance Spectroscopy (MRS) of the brain before and after administration of anti-TNF-alpha. Four patients were neuropsychologically evaluated.
  
  
  RESULTS
  After treatment with TNF-alpha blocking agents the Magnetization Transfer Ratio histogram Peak-heights (MTR-Pht) of the white and gray matter decreased (p < 0.01 and p < 0.05 respectively). The Apparent Diffusion Coefficient for the white and gray matter and the metabolite ratios in the centrum semiovale did not significantly change after therapy. Neuropsychological assessment showed no difference before and after anti-TNF-alpha.
  
  
  CONCLUSIONS
  The decrease of the MTR-Pht after anti-TNF-alpha therapy suggests loss of parenchyma integrity; however, these changes could not be attributed to inflammation or demyelination based on our complementary DWI and MRS data. The decrease of the MTR-Pht did not result in decreased cognitive function.
authors.affiliation: Departments of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. a.e.van_der_bijl@lumc.nl
authors.forename: A E
authors.initials: AE
authors.lastname: van der Bijl
authors.forename: B J
authors.initials: BJ
authors.lastname: Emmer
authors.forename: F C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: H A M
authors.initials: HA
authors.lastname: Middelkoop
authors.forename: C K
authors.initials: CK
authors.lastname: Jurgens
authors.forename: M A
authors.initials: MA
authors.lastname: van Buchem
authors.forename: T W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: J
authors.initials: J
authors.lastname: van der Grond
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000276:immunology / Q000494:pharmacology* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000473:pathology; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D000069285:Infliximab; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D010865:Pilot Projects; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab