Objective Describe advanced and conventional Brain Magnetic Resonance Imaging (MRI) findings in Systemic Erythematosus Lupus (SLE) patients, that attended routine consultation, and identify possible factors associated.

Methods It was a cross-sectional study with forty-two SLE women (2019 EULAR/ACR criteria) that attended medical routine consultation. Brain MRI was performed on 1.5T system, including conventional sequences, diffusion tensor imaging (DTI), MR spectroscopy and MRI angiography without gadolinium (3D Time of Flight). The disease activity and cumulative organ damage were evaluated by SLEDAI and SLICC/ACR damage index. MRI dataset was blindly evaluated by two experienced radiologists. Statistical analysis was performed using JASP and Jamovi softwares.

Results Most of the patients did not have activity disease with neuropsychiatric alterations and have no irreversible organ damage, with SLEDAI less than 8 (70.73%) and SLICC = 0 (75.61%). White Matter Hypersignal Foci (WMHF) was the most frequent finding (61.9%), followed by brain atrophy (38.1%). Artery stenosis occurred in 14.29%, cerebral chronic microbleeds in 14.29% and chronic lacunae infarct in 16.57%. NAA/Creatin ratio was lower in the group with brain atrophy and SLICC>0, denoting reduced neuronal population in this group. Findings of microstructural damage, such as low fractional anisotropy (FA) and high mean diffusibility (DM), were associated with brain atrophy, cerebral microbleed, reduced NAA/Creatin ratio, older age and disease duration.

Conclusions SLE is a possible risk factor for the development of micro and macrostructural brain damage. SLE patients could benefit from brain MRI in diagnosis and follow-up, even in remission or low disease activity. DTI can be used as predictor of cerebral damage, although prospective studies with larger cohorts are needed.