title: A multimodal MRI approach to identify and characterize microstructural brain changes in neuropsychiatric systemic lupus erythematosus.
abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease with multi-organ involvement and results in neurological and psychiatric (NP) symptoms in up to 40% of the patients. To date, the diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE) poses a challenge due to the lack of neuroradiological gold standards. In this study, we aimed to better localize and characterize normal appearing white matter (NAWM) changes in NPSLE by combining data from two quantitative MRI techniques, diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI). 9 active NPSLE patients (37 ± 13 years, all females), 9 SLE patients without NP symptoms (44 ± 11 years, all females), and 14 healthy controls (HC) (40 ± 9 years, all females) were included in the study. MTI, DTI and fluid attenuated inversion recovery (FLAIR) images were collected from all subjects on a 3 T MRI scanner. Magnetization transfer ratio (MTR), mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) maps and white matter lesion maps based on the FLAIR images were created for each subject. MTR and DTI data were then co-analyzed using tract-based spatial statistics and a cumulative lesion map to exclude lesions. Significantly lower MTR and FA and significantly higher AD, RD and MD were found in NPSLE compared to HC in NAWM regions. The differences in DTI measures and in MTR, however, were only moderately co-localized. Additionally, significant differences in DTI measures, but not in MTR, were found between NPSLE and SLE patients, suggesting that the underlying microstructural changes detected by MD are linked to the onset of NPSLE. The co-analysis of the anatomical distribution of MTI and DTI measures can potentially improve the diagnosis of NPSLE and contribute to the understanding of the underlying microstructural damage.
authors.affiliation: C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Ece
authors.initials: E
authors.lastname: Ercan
authors.affiliation: C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Carson
authors.initials: C
authors.lastname: Ingo
authors.affiliation: Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Oranan
authors.initials: O
authors.lastname: Tritanon
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Cesar
authors.initials: C
authors.lastname: Magro-Checa
authors.affiliation: Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA ; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Smith
authors.affiliation: Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA ; Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Smith
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Huizinga
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.affiliation: C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Itamar
authors.initials: I
authors.lastname: Ronen
mesh_terms: D000328:Adult; D056324:Diffusion Tensor Imaging / Q000379:methods; D005260:Female; D006801:Humans; D020945:Lupus Vasculitis, Central Nervous System / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging; D066127:White Matter / Q000473:pathology*
keywords: ACR, American College of Rheumatology; AD, axial diffusivity; DTI, diffusion tensor imaging; Diffusion tensor imaging; FA, fractional anisotropy; FLAIR, fluid attenuated inversion recovery; HC, healthy controls; MD, mean diffusivity; MTI, magnetization transfer imaging; MTR, magnetization transfer ratio; Magnetic resonance imaging; Magnetization transfer imaging; NAWM, normal appearing white matter; NP, neurological and psychiatric; NPSLE, neuropsychiatric systemic lupus erythematosus; Neuropsychiatric systemic lupus erythematosus; Normal appearing white matter; RD, radial diffusivity; SLE, systemic lupus erythematosus; Systemic lupus erythematosus; TBSS, tract based spatial statistics; WM, white matter; WMH, white matter hyperintensities