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P39 Longitudinal changes of cerebral white matter tissue microstructure in early-onset systemic lupus erythematosus
  1. Ettore Silvagni1,
  2. Francesca Inglese2,
  3. Alessandra Bortoluzzi1,
  4. Alfredo Revenaz3,
  5. Massimo Borrelli3,
  6. Margreet Steup-Beekman4,
  7. Tom Huizinga4,
  8. Jeroen De Bresser5,
  9. Itamar Ronen2,
  10. Enrico Fainardi6,
  11. Marcello Govoni1 and
  12. Ece Ercan2
  1. 1Dept. of Medical Sciences, Rheumatology Unit, Ferrara University, Ferrara, Italy
  2. 2Dept. of Radiology, C.J. Gorter Center High Field MRI, Leiden University Medical Center (LUMC), Leiden, The Netherlands
  3. 3Dept. of Neuroscience and Rehabilitation, Ferrara, Italy
  4. 4Dept. of Rheumatology, LUMC, Leiden
  5. 5Dept. of Radiology, LUMC, Leiden, The Netherlands
  6. 6Dept. of Experimental and Clinical Biomedical Sciences, Florence University, Florence, Italy


Background Diffusion tensor imaging (DTI) studies revealed alterations of cerebral white matter (WM) tissue microstructure in patients with established Systemic Lupus Erythematosus (SLE), highlighting longitudinal changes in DTI metrics. The main aim of this study was to evaluate longitudinal variations of DTI metrics in different WM tracts of newly-diagnosed SLE patients.

Methods In a prospective single-centre observational study (2013–2018), patients meeting revised ACR or SLICC classification criteria, aged less than 55, within 24 months from diagnosis, were evaluated with brain MRI (1.5T Philips Achieva) at baseline (T0) and after at least 12 months (FU). DTI data (15 directions, b-value 800s/mm2) were analysed using ExploreDTI software. Automatic lesion segmentation was performed using Lesion Prediction Algorithm (Matlab16). An in-house developed semi-automated WM tracts segmentation algorithm was used to assess fractional anisotropy (FA), mean (MD), radial (RD), axial diffusivity (AD) values in different normal-appearing WM tracts. Variations in neuroimaging data were analysed by Wilcoxon matched-pairs signed-ranks test.

Results 17 early SLE patients were included. After mean 456.3(87.1) days, mean(SD) FA values significantly decreased at left corticospinal tract (T0: 0.483(0.032); FU: 0.470(0.034), p=0.0040) and posterior limb of left internal capsule (0.590(0.020) vs 0.580(0.024), p=0.0396), with increase in MD (0.755 vs 0.770, p=0.0023) and RD values (0.467 vs 0.482, p=0.0019) (figure 1). Increase in MD and RD values was independent of baseline neurologic symptoms, disease activity and comorbidities.

Abstract P39 Figure 1

Axial FA and MD maps with overlying WM tracts (thresholded by the WM probability map), showing posterior limb of left internal capsule (arrows); variation of main DTI parameters (FA, MD, RD, AD) between T0 and FU at posterior limb of left internal capsule

Conclusions Longitudinal decrease in FA and increase in MD start in early phases of SLE course, even in absence of overt NP symptoms, reflecting a compromised WM tissue microstructure.

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