title: Brain abnormalities in newly diagnosed neuropsychiatric lupus: systematic MRI approach and correlation with clinical and laboratory data in a large multicenter cohort.
abstract: OBJECTIVE
  To describe brain magnetic resonance imaging (MRI) abnormalities in newly diagnosed neuropsychiatric lupus (NPSLE). To correlate them with clinical and laboratory data.
  
  
  METHODS
  This retrospective cross-sectional study included patients presenting NPSLE undergoing brain MRI within 6 months after onset between 2003 and 2012. Clinical and laboratory data were recorded. MRI findings were defined as inflammatory-like, large-vessel disease (LVD), and small-vessel disease (SVD); SVD was classified as white-matter hyperintensities (WMH), recent small subcortical infarcts, lacunes, microbleeds, and brain atrophy.
  
  
  RESULTS
  We included 108 patients (mean 40.6 ± 14.2 years; range 14-77), 91.7% women. The most frequent syndromes were headache (28.5%), cerebrovascular disease (15.5%), seizure (15.5%), and cognitive dysfunction (11.4%). Brain abnormalities were found in 59.3%. SVD was the most common (55.6%), followed by LVD (13%) and inflammatory-like lesions (6.5%). The most frequent SVD findings were WMH (53.7%), atrophy (18.5%), microbleeds (13.7%) and lacunes (11.1%). Cerebrovascular syndrome correlated with LVD (p = 0.001) and microbleeds (p = 0.002), cognitive dysfunction with WMH (p = 0.045) and myelopathy with inflammatory-like lesions (p = 0.020). Low C4 and CH50 correlated with inflammatory-like lesions (p < 0.001, p = 0.019) and lupus anticoagulant with WMH (p = 0.018), microbleeds (p = 0.002) and atrophy (p = 0.008).
  
  
  CONCLUSIONS
  Vascular disease is the hallmark of NPSLE. Certain syndromes and immunological patterns are prone to more extensive brain damage. MRI could provide significant clinical information and insights into the pathological substrate.
authors.affiliation: Department of Neuroradiology, Hospital Clinic, Barcelona, Catalonia, Spain.
authors.forename: Nicolae
authors.initials: N
authors.lastname: Sarbu
authors.affiliation: Department of Neuroradiology, The National Hospital of Neurology and Neurosurgery, London, UK.
authors.forename: Farah
authors.initials: F
authors.lastname: Alobeidi
authors.affiliation: Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Toledano
authors.affiliation: Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Espinosa
authors.affiliation: Department of Rheumatology, University College Hospital, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Giles
authors.affiliation: Department of Rheumatology, University College Hospital, London, UK.
authors.forename: Anisur
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Department of Neuroradiology, The National Hospital of Neurology and Neurosurgery, London, UK.
authors.forename: Tarek
authors.initials: T
authors.lastname: Yousry
authors.affiliation: Department of Neuroradiology, Hospital Clinic, Barcelona, Catalonia, Spain.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Capurro
authors.affiliation: Department of Neuroradiology, The National Hospital of Neurology and Neurosurgery, London, UK.
authors.forename: Rolf
authors.initials: R
authors.lastname: Jäger
authors.affiliation: Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Cervera
authors.affiliation: Department of Neuroradiology, Hospital Clinic, Barcelona, Catalonia, Spain; Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Electronic address: bargallo@clinic.cat.
authors.forename: Nuria
authors.initials: N
authors.lastname: Bargalló
mesh_terms: D000818:Animals; D001921:Brain / Q000473:pathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006801:Humans; D020945:Lupus Vasculitis, Central Nervous System / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies
keywords: Low complement levels; Lupus anticoagulant; Magnetic resonance imaging; Neuropsychiatric disorders; Systemic lupus erythematosus