Quantitative magnetic resonance imaging analyses and clinical significance of hyperintense white matter lesions in systemic lupus erythematosus patients.
OBJECTIVE
To analyze the clinical significance of hyperintense white matter (WM) lesions in both symptomatic and asymptomatic systemic lupus erythematosus (SLE) patients.


METHODS
We studied 120 consecutive SLE patients and 44 healthy volunteers. Fluid attenuated inversion recovery and T2-weighted magnetic resonance images (MRI) were used for visual and semiautomatic volumetric measurements.


RESULTS
At baseline, 61 MRI were normal and 59 had hyperintense WM lesions. Mean volumes of WM lesions were 96.14 (SD = 85.14) mm(3) in T2 weighted and 197.2 (161.13) mm(3) in FLAIR images. The volume of WM lesions was associated with age (r = 0.45; p = 0.01), total corticosteroid dose (r = 0.53; p = 0.001), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores (r = 0.55; p = 0.002). After a median follow-up time of 24 months (SD = 2.3; range = 12-28 months), 20 patients had still normal MRIs, 30 patients had stable MRI findings, and 30 had new WM lesions. Predictors for new or increased WM lesions were past central nervous system manifestations (p = 0.001; OR = 12.2; 95% CI = 3.5-21.2), antiphospholipid antibodies (p = 0.003; OR = 6.9; 95% CI = 2.1-15.3); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores (p = 0.002; OR = 7.2; 95% CI = 1.4-17.8) and higher dose of total corticosteroid dose (p = 0.01; OR = 2.4; 95% CI = 1.4-6.7).


CONCLUSIONS
Small hyperintense WM lesions in SLE are associated with central nervous system symptoms and antiphospholipid antibodies, and progress over time in patients with more severe SLE. Therefore, in the context of SLE, these lesions are likely consequences of central nervous system damage and not mere incidental finding.
Appenzeller
Simone
S
Department of Rheumatology, State University of Campins, São Paulo, São Paulo, Brazil.
Vasconcelos Faria
Andrea
A
Li
Li Min
LM
Costallat
Lilian T L
LT
Cendes
Fernando
F
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011446:Prospective Studies; D055815:Young Adult