Inglese, Francesca, Kant, Ilse M J, Monahan, Rory C, Steup-Beekman, Gerda M, Huizinga, Tom W J, van Buchem, Mark A, Magro-Checa, Cesar, Ronen, Itamar and de Bresser, Jeroen (2021) Different phenotypes of neuropsychiatric systemic lupus erythematosus are related to a distinct pattern of structural changes on brain MRI. European Radiology (ER), 31 (11). pp. 8208-8217. ISSN 0938-7994

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Abstract

Objectives
The underlying structural brain correlates of neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) remain unclear, thus hindering correct diagnosis.

We compared brain tissue volumes between a clinically well-defined cohort of patients with NPSLE and SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE). Within the NPSLE patients, we also examined differences between patients with two distinct disease phenotypes: ischemic and inflammatory.

Methods
In this prospective (May 2007 to April 2015) cohort study, we included 38 NPSLE patients (26 inflammatory and 12 ischemic) and 117 non-NPSLE patients. All patients underwent a 3-T brain MRI scan that was used to automatically determine white matter, grey matter, white matter hyperintensities (WMH) and total brain volumes. Group differences in brain tissue volumes were studied with linear regression analyses corrected for age, gender, and total intracranial volume and expressed as B values and 95% confidence intervals.

Results
NPSLE patients showed higher WMH volume compared to non-NPSLE patients (p = 0.004). NPSLE inflammatory patients showed lower total brain (p = 0.014) and white matter volumes (p = 0.020), and higher WMH volume (p = 0.002) compared to non-NPSLE patients. Additionally, NPSLE inflammatory patients showed lower white matter (p = 0.020) and total brain volumes (p = 0.038) compared to NPSLE ischemic patients.

Conclusion
We showed that different phenotypes of NPSLE were related to distinct patterns of underlying structural brain MRI changes. Especially the inflammatory phenotype of NPSLE was associated with the most pronounced brain volume changes, which might facilitate the diagnostic process in SLE patients with neuropsychiatric symptoms.

Item Type:	Article
Keywords:	Brain, Lupus erythematosus, Systemic, Magnetic resonance imaging, Phenotype, Brain, Cohort Studies, Humans, Lupus Erythematosus, Systemic, Lupus Vasculitis, Central Nervous System, Magnetic Resonance Imaging, Phenotype, Prospective Studies
Schools and Departments:	Brighton and Sussex Medical School > Neuroscience
SWORD Depositor:	Mx Elements Account
Depositing User:	Mx Elements Account
Date Deposited:	01 Feb 2022 09:54
Last Modified:	01 Feb 2022 10:00
URI:	http://sro.sussex.ac.uk/id/eprint/104119

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