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Value of MRI of the brain in patients with systemic lupus erythematosus and neurologic disturbance

  • Diagnostic Neuroradiology
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Abstract

Our objective was to review the frequency and pattern of signal abnormalities seen on conventional MRI in patients with suspected neuropsychiatric systemic lupus erythematosus (NP-SLE). We reviewed 116 MRI examinations of the brain performed on 85 patients with SLE, (81 women, four men, aged 21–78 years, mean 40.6 years) presenting with neurological disturbances. MRI was normal or nearly normal in 34%. In 60% high-signal lesions were observed on T2-weighted images, frequently in the frontal and parietal subcortical white matter. Infarct-like lesions involving gray and white matter were demonstrated in 21 of cases. Areas of restricted diffusion were seen in 12 of the 67 patients who underwent diffusion-weighted imaging. Other abnormalities included loss of brain volume, hemorrhage, meningeal enhancement, and bilateral high signal in occipital white-matter. The MRI findings alone did not allow us to distinguish between thromboembolic and inflammatory events in many patients. Some patients with normal MRI improved clinically while on immunosuppressive therapy. More sensitive and/or specific imaging methods, such as spectroscopy and perfusion-weighted imaging, should be investigated in these subgroups of patients with suspected NP-SLE.

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References

  1. Kovacs J, Urowitz M, Gladman D (1993) Dilemmas in neuropsychiatric lupus. Rheum Dis Clin North Am 19: 795–819

    CAS  PubMed  Google Scholar 

  2. ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature (1999) The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42: 599–608

    Article  PubMed  Google Scholar 

  3. Schumacher HR (ed) (1993) Primer on the rheumatic diseases, 10th ed. Arthritis Foundation, Atlanta, pp 100–117

  4. West SG, Emlen W, Wener MH, Kotzin BL (1995) Neuropsychiatric lupus erythematosus: a 10-year prospective study on the value of diagnostic tests. Am J Med 99: 153–163

    Article  CAS  PubMed  Google Scholar 

  5. Pomper M, Miller T, Stone J, Tidmore W, Hellman D (1999) CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. AJNR 20: 75–85

    CAS  Google Scholar 

  6. McCune J, MacGuire A, Aisen A, Gebarski S (1988) Identification of brain lesions in neuropsychiatric systemic lupus erythematosus by magnetic resonance scanning. Arthritis Rheum 31: 159–166

    CAS  PubMed  Google Scholar 

  7. Jacobs L, Kinkel P, Costello PB, Alukal MK, Kinkel WR, Green FA (1988) Central nervous system lupus erythematosus: the value of magnetic resonance imaging. J Rheumatol 15: 601–606

    CAS  PubMed  Google Scholar 

  8. Sibbitt WL Jr, Sibbitt RR, Griffey RH, Eckel C, Bankhurst AD (1989) Magnetic resonance and computed tomographic imaging in the evaluation of acute neuropsychiatric disease in systemic lupus erythematosus. Ann Rheum Dis 12: 1014–1022

    Google Scholar 

  9. Bell CL, Partington C, Robbins M, Graciano F, Turski P, Kornguth S (1991) Magnetic resonance imaging of central nervous system lesions in patients with lupus erythematosus. Correlation with clinical remission and antineurofilament and anticardiolipin antibody titers. Arthritis Rheum 34: 432–441

    CAS  PubMed  Google Scholar 

  10. Baum KA Hopf U, Nehrig C, Stover M, Schorner W (1993) Systemic lupus erythematosus: Neuropsychiatric signs and symptoms related to cerebral MRI findings. Clin Neurol Neurosurg 95: 29–34

    Article  CAS  PubMed  Google Scholar 

  11. Stimmler MM, Coletti PM, Quismorio FP Jr (1993) Magnetic resonance imaging of the brain in neuropsychiatric systemic lupus erythematosus. Semin Arthritis Rheum 22: 335–349

    CAS  PubMed  Google Scholar 

  12. González-Crespo MR, Blanco FJ, Ciruelo E, Mateo I, López Pino MA, Gómez-Reino JJ (1995) Magnetic resonance imaging of the brain in systemic lupus erythematosus. Br J Rheumatol 34: 1055–1060

    CAS  PubMed  Google Scholar 

  13. Tanabe J, Weiner MW (1997) MRI-MRS of the brain in systemic lupus erythematosus. How do we use it to understand causes of clinical signs? Ann N Y Acad Sci 823: 169–184

    CAS  PubMed  Google Scholar 

  14. Sibbitt WL Jr, Sibbitt RR, Brooks WM (1999) Neuroimaging in neuropsychiatric systemic lupus erythematosus. Arthritis Rheum 42: 2026–2038

    PubMed  Google Scholar 

  15. Tan E, Cohen A, Fries J, et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25: 1271–1277

    PubMed  Google Scholar 

  16. Ellis SG, Verity MA (1979) Central nervous system involvement in systemic lupus erythematosus: a review of neuropathologic findings in 57 cases, 1955–1977. Semin Arthritis Rheum 8: 212–221

    CAS  PubMed  Google Scholar 

  17. Van Dam AP (1991) Diagnosis and pathogenesis of CNS lupus. Rheumatol Intl 11: 1–11

    Google Scholar 

  18. Belmont MH, Abramson SB, Lie JT (1996) Pathology and pathogenesis of vascular injury in systemic lupus erythematosus. Arthritis Rheum 39: 9–22

    CAS  PubMed  Google Scholar 

  19. Sanna G, Piga M, Terryberry JW, et al (2000) Central nervous system involvement in systemic lupus erythematosus: cerebral imaging and serological profile in patients with and without overt neuropsychiatric manifestations. Lupus 9: 573–583

    CAS  PubMed  Google Scholar 

  20. Provenzale JM, Barboriak DP, Allen NB, Ortel TL (1996) Patients with antiphospholipid antibodies: CT and MR findings of the brain. Am J Roentgenol 167: 1573–1578

    CAS  Google Scholar 

  21. Provenzale JM, Barboriak DP, Allen NB, Ortel TL (1998) Antiphospholipid antibodies: findings at arteriography. AJNR 19: 611–616

    CAS  PubMed  Google Scholar 

  22. Karassa FB, Ioannidis JP, Boki KA, et al (2000) Predictors of clinical outcome and radiologic progression in patients with neuropsychiatric manifestations of systemic lupus erythematosus. Am J Med 109: 628–634

    CAS  PubMed  Google Scholar 

  23. Sibbitt WL Jr, Haseler LJ, Griffey RH, Hart BL, Sibbitt RR, Matwiyoff NA (1994) Analysis of cerebral structural changes in systemic lupus erythematosus by proton MR spectroscopy. AJNR 15: 923–928

    Google Scholar 

  24. Chinn RJ, Wilkinson ID, Hall-Craggs MA, et al (1997) Magnetic resonance imaging of the brain and cerebral proton spectroscopy in patients with systemic lupus erythematosus. Arthritis Rheum 40: 36–46

    CAS  PubMed  Google Scholar 

  25. Sibbitt WL Jr, Haseler LJ, Griffey RR, Friedman SD, Brooks WM (1997) Neurometabolism of active neuropsychiatric lupus determined with proton MR spectroscopy. AJNR 18: 1271–1277

    Google Scholar 

  26. Friedman SD, Stidley CA, Brooks WM, Hart BL, Sibbitt WL Jr (1998) Brain injury and neurometabolic abnormalities in systemic lupus erythematosus. Radiology 209: 79–84

    CAS  PubMed  Google Scholar 

  27. Lim MK, Suh CH, Kim HJ, et al (2000) Systemic lupus erythematosus: brain MR imaging and single-voxel1H MR spectroscopy. Radiology 217: 43–49

    CAS  PubMed  Google Scholar 

  28. Axford JS, Howe FA, Heron C, Griffiths JR (2001) Sensitivity of quantitative1H magnetic resonance spectroscopy of the brain in detecting early neuronal damage in systemic lupus erythematosus. Ann Rheum Dis 60: 106–111

    Article  CAS  PubMed  Google Scholar 

  29. Yuh W, Ueda T, Maley J (1998) Perfusion and diffusion imaging: a potential tool for improved diagnosis of CNS vasculitis. AJNR 20: 87–89

    Google Scholar 

  30. Moritani T, Shrier DA, Numaguchi Y, et al (2001) Diffusion-weighted echo-planar MR imaging of CNS involvement in systemic lupus erythematosus. Acad Radiol 8: 741–753

    CAS  PubMed  Google Scholar 

  31. Marullo S, Clauvel JP, Intrator L, Danon F, Brouet JC, Oksenhendler E (1993) Lupoid sclerosis with antiphospholipid antibodies. J Rheumatol 20: 747–749

    CAS  PubMed  Google Scholar 

  32. Scott TF, Brillman J (1994) Antiphospholipid antibody syndrome mimicking multiple sclerosis and systemic lupus erythematosus clinically and by magnetic resonance imaging. Arch Intern Med 154: 917–920

    Article  CAS  PubMed  Google Scholar 

  33. Attwood J, Sundgren PC, West A, Cinti S, McKeever P (2002) Progressive multifocal leukoencephalopathy (PML) in a patient with systemic lupus erythematosus. Co-existence of PML and lupus central nervous system disease, or PML masquerading as lupus CNS disease? Case report and review of the literature. In press

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA

    J. E. Jennings, P. C. Sundgren & P. Maly

  2. Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA

    J. Attwood & J. McCune

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  1. J. E. Jennings
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  2. P. C. Sundgren
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  3. J. Attwood
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  4. J. McCune
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  5. P. Maly
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Correspondence to P. C. Sundgren.

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Jennings, J.E., Sundgren, P.C., Attwood, J. et al. Value of MRI of the brain in patients with systemic lupus erythematosus and neurologic disturbance. Neuroradiology 46, 15–21 (2004). https://doi.org/10.1007/s00234-003-1049-2

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  • DOI: https://doi.org/10.1007/s00234-003-1049-2

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