Multimodal imaging in systemic lupus erythematosus patients with diffuse neuropsychiatric involvement

Objectives The objective of this paper is to investigate conventional and nonconventional brain magnetic resonance imaging (MRI) findings in systemic lupus erythematosus (SLE) patients with diffuse neuropsychiatric involvement (dNPSLE) compared to healthy controls (HCs). Methods Twenty-six (26) SLE patients with one or more diffuse NP syndromes related to the central nervous system (CNS) (dNPSLE) and 36 age- and sex-matched HCs were scanned on a 3T MRI using a multimodal imaging approach. Univariate and multivariate analyses were used to determine MRI-specific measure differences between dNPSLE and HCs for lesion burden, tissue-specific atrophy, magnetization transfer ratio (MTR) and diffusion-tensor imaging (DTI) outcomes. Results In univariate analyses, dNPSLE patients showed significantly increased T1 lesion number ( p = .001) and T1-lesion volume (LV, p = .008) compared to HCs. dNPSLE patients showed decreased whole brain volume ( p < .0001), gray matter volume ( p < .0001), cortical volume ( p < .0001) and increased lateral ventricle volume ( p = .004) compared to HCs. dNPSLE patients had increased axial diffusivity (AD) of NAWM ( p = .008) and NA brain tissue ( p = .017) compared to HCs. In the multivariate regression analysis, decreased cortical volume was associated with SLE ( R 2 = 0.59, p < .0001). Conclusions This study shows that cortical and central atrophy are associated with SLE patients with diffuse CNS syndromes. Microscopic tissue injury in the NAWM on AD DTI measures in SLE patients indicates a predominant reduction of axonal density.