title: Neuropsychiatric systemic lupus erythematosus: lessons learned from magnetic resonance imaging.
abstract: OBJECTIVE
  The clinical manifestations of nervous system involvement in systemic lupus erythematosus (neuropsychiatric SLE [NPSLE]) are highly diverse, and their etiology is incompletely understood. The aim of this study was to provide an inventory of abnormalities on conventional brain magnetic resonance imaging (MRI) in NPSLE and to interpret the findings in relation to possible underlying pathogenetic mechanisms.
  
  
  METHODS
  MR images of the first episode of active NPSLE in 74 patients were retrospectively reviewed. All patients fulfilled the American College of Rheumatology (ACR) 1982 revised criteria for the classification of SLE and were classified according to the 1999 ACR case definitions for NPSLE syndromes. We excluded patients with a history of brain disease and patients in whom other mechanisms unrelated to SLE caused the neuropsychiatric symptoms.
  
  
  RESULTS
  The principal findings were: 1) focal hyperintensities in white matter (WM) (49% of all patients) or both WM and gray matter (GM) (5% of all patients), suggestive of vasculopathy or vasculitis; 2) more widespread, confluent hyperintensities in the WM, suggestive of chronic hypoperfusion due to the same mechanisms; 3) diffuse cortical GM lesions (12% of all patients), compatible with an immune response to neuronal components or postseizure changes; and 4) absence of MRI abnormalities, despite signs and symptoms of active disease (42% of all patients).
  
  
  CONCLUSIONS
  Several distinct brain MRI patterns were observed in patients with active NPSLE, suggestive of different pathogenetic mechanisms. To advance our understanding of the various processes leading to NPSLE, the radiographic manifestations may be a good starting point and useful for categorization of patients in further research.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. j.luyendijk@lumc.nl
authors.forename: J
authors.initials: J
authors.lastname: Luyendijk
authors.forename: S C A
authors.initials: SC
authors.lastname: Steens
authors.forename: W J N
authors.initials: WJ
authors.lastname: Ouwendijk
authors.forename: G M
authors.initials: GM
authors.lastname: Steup-Beekman
authors.forename: E L E M
authors.initials: EL
authors.lastname: Bollen
authors.forename: J
authors.initials: J
authors.lastname: van der Grond
authors.forename: T W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: B J
authors.initials: BJ
authors.lastname: Emmer
authors.forename: M A
authors.initials: MA
authors.lastname: van Buchem
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000145:classification / Q000473:pathology; D020945:Lupus Vasculitis, Central Nervous System / Q000145:classification / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020293:Vasculitis, Central Nervous System / Q000145:classification / Q000473:pathology*; D055815:Young Adult