Neuropsychiatric lupus or not? Cerebral hypoperfusion by perfusion-weighted MRI in normal-appearing white matter in primary neuropsychiatric lupus erythematosus
Annals of the Rheumatic Diseases, ISSN: 0003-4967, Vol: 77, Issue: 3, Page: 441-449
2018
- 47Citations
- 61Captures
- 1Mentions
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Metrics Details
- Citations47
- Citation Indexes47
- 47
- CrossRef46
- Captures61
- Readers61
- 61
- Mentions1
- News Mentions1
- News1
Most Recent News
Cerebral Microstructural and Microvascular Changes in Non-Neuropsychiatric Systemic Lupus Erythematosus: A Study Using Diffusion Kurtosis Imaging and 3D Pseudo-Continuous Arterial Spin Labeling
Introduction Systemic lupus erythematosus (SLE) is a chronic, recurring, female-predominant autoimmune connective tissue disorder that affects various organ systems, including the central nervous system. In
Article Description
Cerebral perfusion abnormalities have been reported in systemic lupus erythematosus (SLE) but their value in distinguishing lupus from non-lupus-related neuropsychiatric events remains elusive. We examined whether dynamic susceptibility contrast-enhanced perfusion MRI (DSC-MRI), a minimally invasive and widely available method of cerebral perfusion assessment, may assist neuropsychiatric SLE (NPSLE) diagnosis. In total, 76patients with SLE (37 primary NPSLE, 16 secondary NPSLE, 23 non-NPSLE) and 31 healthy controls underwent conventional MRI (cMRI) and DSC-MRI. Attribution of NPSLE to lupus or not was based on multidisciplinary assessment including cMRI results and response to treatment. Cerebral blood volume and flow were estimated in 18 normal-appearing white and deep grey matter areas. The most common manifestations were mood disorder, cognitive disorder and headache. Patients with primary NPSLE had lower cerebral blood flow and volume in several normal-appearing white matter areas compared with controls (P<0.0001) and lower cerebral blood flow in the semioval centre bilaterally, compared with non-NPSLE and patients with secondary NPSLE (P<0.001). A cut-off for cerebral blood flow of 0.77 in the left semioval centre discriminated primary NPSLE from non-NPSLE/secondary NPSLE with 80% sensitivity and 67%–69% specificity. Blood flow values in the left semioval centre showed substantially higher sensitivity than cMRI (81% vs 19%–24%) for diagnosing primary NPSLE with the combination of the two modalities yielding 94%–100% specificity in discriminating primary from secondary NPSLE. Primary NPSLE is characterised by significant hypoperfusion in cerebral white matter that appears normal on cMRI. The combination of DSC-MRI-measured blood flow in the brain semioval centre with conventional MRI may improve NPSLE diagnosis.
Bibliographic Details
http://www.sciencedirect.com/science/article/pii/S0003496724009737; http://dx.doi.org/10.1136/annrheumdis-2017-212285; http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85053567405&origin=inward; http://www.ncbi.nlm.nih.gov/pubmed/29259047; https://linkinghub.elsevier.com/retrieve/pii/S0003496724009737; https://dx.doi.org/10.1136/annrheumdis-2017-212285; https://ard.bmj.com/content/77/3/441
Elsevier BV
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