Evaluation of white matter integrity in systemic lupus erythematosus by diffusion tensor magnetic resonance imaging: a study using tract-based spatial statistics.
BACKGROUND
The aim of this study was to evaluate the white matter integrity in brains of patients with systemic lupus erythematosus (SLE) using a voxel-based analyses of diffusion tensor imaging (DTI) data.


METHODS
Fifty-seven patients with SLE were compared to 36 control patients who were matched by gender, age, education, and Mini Mental State Examination score. DTI was performed along 30 noncollinear directions in a 1.5 Tesla scanner. For tract-based spatial statistics (TBSS), a white matter skeleton was created, and a permutation-based inference with 5000 permutations and a threshold of p < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The mean (MD), radial (RD), and axial diffusivities (AD) were also projected onto the mean FA skeleton.


RESULTS
We found a significant decrease of global FA in SLE patients compared to controls. The areas of reduced FA included the right superior corona radiata, the right superior longitudinal fasciculus, the body of the corpus callosum, the right inferior fronto-occipital fasciculus, the right thalamic radiation, and the right uncinate fasciculus. Patients with SLE also had increased AD and RD in several areas. Substantial overlap of areas with increased AD and RD occurred and were spatially much more extensive than the areas of reduced FA.


CONCLUSIONS
Significant increases of AD values were concordant to those of RD and MD and more extensive than FA changes. Analyzing all diffusivity parameters, using TBSS, can detect more white matter microstructural changes in patients with SLE than analyzing FA alone.
Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil. diogogoulartcorrea@yahoo.com.br.|Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil. diogogoulartcorrea@yahoo.com.br.
Diogo Goulart
DG
Corrêa
Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.|Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Nicolle
N
Zimmermann
Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.
Denis Batista
DB
Pereira
Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil.
Thomas M
TM
Doring
Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.
Tania Maria
TM
Netto
Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.|Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil.
Nina
N
Ventura
Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.|Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Rochele Paz
RP
Fonseca
Department of Radiology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Rodolpho Paulo Rocco 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.|Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil.
Emerson Leandro
EL
Gasparetto
D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003198:Computer Simulation; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D020945:Lupus Vasculitis, Central Nervous System / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D015233:Models, Statistical; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D066127:White Matter / Q000000981:diagnostic imaging* / Q000473:pathology*
Demyelination; Diffusion tensor imaging; Magnetic resonance imaging; Systemic lupus erythematosus; Wallerian degeneration