title: Efficacy of magnetic resonance diffusion tensor imaging and three-dimensional fiber tractography in the detection of clinical manifestations of central nervous system lupus.
abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease frequently associated with neuropsychiatric manifestations. No follow-up case report has characterized white matter alterations in patients with neuropsychiatric lupus erythematosus (NPSLE) before and after treatment. In this study, a 16-year-old NPSLE patient with severe neuropsychological symptoms was treated with steroid pulse therapy, and was scanned with conventional magnetic resonance (MR) and diffusion tensor imaging (DTI) at onset and 17months after treatment. Conventional MR images showed diffuse brain atrophy and focal vasogenic edema in the putamen, but they did not reveal abnormalities in the corpus callosum. Region-of-interest analysis of DTI images showed that fractional anisotropy and fiber tracts increased significantly, while axial diffusivity, radial, and mean diffusivity decreased significantly in the corpus callosum after treatment. The results indicated that the vasogenic edema was present in the corpus callosum at onset and was significantly reduced after treatment. These changes were generally compatible with the patient's clinical manifestations. Hence, we concluded that MR-DTI and fiber tractography are helpful to reveal the relationship between white matter alterations and neurological dysfunctions in NPSLE patients.
authors.affiliation: Department of Medical Imaging, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Shiou-Ping
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Chien-Sheng
authors.initials: CS
authors.lastname: Wu
authors.affiliation: Department of Medical Imaging, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Li-Chun
authors.initials: LC
authors.lastname: Hsieh
authors.affiliation: Department of Medical Imaging, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Wing-Keung
authors.initials: WK
authors.lastname: Cheung
authors.affiliation: Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: mcchou@kmu.edu.tw.
authors.forename: Ming-Chung
authors.initials: MC
authors.lastname: Chou
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D020945:Lupus Vasculitis, Central Nervous System / Q000473:pathology*; D064847:Multimodal Imaging / Q000379:methods*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Corpus callosum; DTI; Fiber tractography; NPSLE