title: Multimodal imaging in systemic lupus erythematosus patients with diffuse neuropsychiatric involvement.
abstract: OBJECTIVE
  The objective of this paper is to investigate conventional and nonconventional brain magnetic resonance imaging (MRI) findings in systemic lupus erythematosus (SLE) patients with diffuse neuropsychiatric involvement (dNPSLE) compared to healthy controls (HCs).
  
  
  METHODS
  Twenty-six (26) SLE patients with one or more diffuse NP syndromes related to the central nervous system (CNS) (dNPSLE) and 36 age- and sex-matched HCs were scanned on a 3T MRI using a multimodal imaging approach. Univariate and multivariate analyses were used to determine MRI-specific measure differences between dNPSLE and HCs for lesion burden, tissue-specific atrophy, magnetization transfer ratio (MTR) and diffusion-tensor imaging (DTI) outcomes.
  
  
  RESULTS
  In univariate analyses, dNPSLE patients showed significantly increased T1 lesion number (p = .001) and T1-lesion volume (LV, p = .008) compared to HCs. dNPSLE patients showed decreased whole brain volume (p < .0001), gray matter volume (p < .0001), cortical volume (p < .0001) and increased lateral ventricle volume (p = .004) compared to HCs. dNPSLE patients had increased axial diffusivity (AD) of NAWM (p = .008) and NA brain tissue (p = .017) compared to HCs. In the multivariate regression analysis, decreased cortical volume was associated with SLE (R (2) = 0.59, p < .0001).
  
  
  CONCLUSIONS
  This study shows that cortical and central atrophy are associated with SLE patients with diffuse CNS syndromes. Microscopic tissue injury in the NAWM on AD DTI measures in SLE patients indicates a predominant reduction of axonal density.
authors: Buffalo Neuroimaging Analysis Center, State University of New York at Buffalo, NY 14203, USA. rzivadinov@bnac.net
authors: R
authors: R
authors: Zivadinov
authors: J L
authors: JL
authors: Shucard
authors: S
authors: S
authors: Hussein
authors: J
authors: J
authors: Durfee
authors: J L
authors: JL
authors: Cox
authors: N
authors: N
authors: Bergsland
authors: M G
authors: MG
authors: Dwyer
authors: R H B
authors: RH
authors: Benedict
authors: J
authors: J
authors: Ambrus
authors: D W
authors: DW
authors: Shucard
mesh_terms: D000328:Adult; D001369:Axons / Q000378:metabolism; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D020945:Lupus Vasculitis, Central Nervous System / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis
keywords: Healthy controls; axial and radial diffusivity; cortical atrophy; diffusion tensor imaging; lesion burden; magnetization transfer imaging; neuropsychiatric systemic lupus erythematosus; subcortical atrophy; white matter injury