The results of volumetry measurement of brain pathological lesions in patients with systemic lupus erythematosus

Authors: L. Podrazilová 1;  V. Peterová 2;  D. Tegzová 1;  M. Olejárová 1;  J. Krásenský 2;  Z. Seidl 3;  P. Kozelek 4;  A. Dohnalová 5;  C. Dostál 1
Authors‘ workplace: Revmatologický ústav, Praha, 2MR oddělení Radiodiagnostické kliniky, 1. LF UK Praha, 3Neurologická klinika 1. LF UK Praha, 4Psychiatrická klinika, 1. LF UK Praha, 5Fyziologický ústav, 1. LF UK Praha 1
Published in: Čes. Revmatol., 16, 2008, No. 2, p. 74-80.
Category: Original Papers


Our project study presents the results of measuring the volume of pathological foci in the brain tissue of patients suffering from systemic lupus erytematosus (SLE) with or without neuropsychiatric manifestations (NP). Magnetic resonance (MR) scans of patients with SLE and, in particular, signs of neuropsychiatric involvement show pathological foci in the cerebral white matter. Methods: A total of 53 SLE patients, 29 with signs of neuropsychiatric syndromes (NPSLE), 24 without, and 16 healthy controls underwent prospective volumetric magnetic resonance imaging in a flow attenuated inversion recovery (FLAIR) sequence. The disease activity was expressed in terms of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Results: All of the patients in this study were found to have a larger volume of pathological foci in the brain tissue than the healthy controls. The NPSLE subgroup had a larger volume of pathological foci than the SLE patients without NP (p < 0.001). The largest volume of such foci was found in patients with a history of cerebrovascular disease (p < 0.05). These were also noted for a correlation between the duration of the disease and the period of time elapsed from the onset of the first signs of neuropsychiatric lupus (p < 0.01).Correlation with SLEDAI-rated disease activity was found statistically significant in all of the patients (p < 0.05), in those with NPSLE at a level of p < 0.01. Conclusion: We found that lesion load was significantly larger in NPSLE patients than in non-NPSLE patients and controls. Lesion load correlated with SLEDAI in the whole group of SLE patients and in the subgroup with NP manifestation. MR is so far the most sensitive method for visualising pathological foci in the brain tissue as abnormalities are demonstrable also in SLE patients free from NP. In the future, longitudinal volumetry might conceivably facilitate therapeutical effect rating.

Key words:
systemic lupus erythematosus, neuropsychiatric lupus, magnetic resonance, volumetry, „lesion load“, FLAIR sequence


1. West SG. Neuropsychiatric lupus. Rheum Dis Clin North Am 1994; 20:129-158.

2. Sibbitt WL Jr, Brandt JR, Johnson CR, et al. The incidence and prevalence of neuropsychiatric syndromes in pediatric onset systemic lupus erythematosus. J Rheumatol 2002; 29: 1536–1542.

3. ACR Ad hoc Committee on Neuropsychiatric Lupus Nomenclature: The American College of Rheumatology Nomenclature and Case Definitions for Neuropsychiatric Syndromes. Arthritis Rheum 1999; 42: 1649–1652.

4. Wolf J, Niedermaier A, Bergner R, Lowitzsch K. Zerabrale vaskulitis als Erstmanifestation eines systemischen Lupus erythematodes. Dtsch Med Wschr 2001; 126: 947–950.

5. Sewell KL, Livneh A, Aranow CB, Grayze AI. Magnetic resonance imaging versus computed tomographic scanning in neuropsychiatric systemic lupus erythematosus. Am J Med 1989; 86(5): 625–626.

6. Sibbitt WL Jr, Sibbitt RR, Grifey RH, Eckel C, Bankhurst AD. Magnetic resonance and computed tomographic imaging in the evaluation of acute neuropsychiatric disease in systemic lupus erytethematosus. Ann Rheum Dis 1989: 48: 1014–1022.

7. Sibbitt WL, Schmidt PJ, Blaine LH, Brooks WM. Fluid Attenuated Inversion Recovery (FLAIR) Imaging in Neuropsychiatric Systemic Lupus Erythematosus. J Rheumatol 2003; 30: 1983–1989.

8. Tourbah A, Deschamps R, Stievenart JL. Magnetic resonance imaging using FLAIR pulse sequence in white matter diseases. J Neuroradiol 1996; 23: 217–222.

9. Bruyn GA. Controversies in lupus: nervous systém involvement. Ann Rheum Dis 1995; 54:159–167. Ed. Mosby 1999; USA 1255–1274.

10. Jarek MJ, West SG, Baker MR, Rak KM. Magnetic resonance imaging in systemic lupus erythematosus patients without a history of neuropsychiatric lupus erythematosus. Arthritis Rheum 1994; 37: 1609–1613.

11. Sanna G, Piga M, Terryberry JW, Peltz MT, Giagheddu S, Satta L. Central nervous system involvement in systemic lupus erythematosus: cerebral imaging and serological profile in patients with and without overt neuropsychiatric manifestations. Lupus 2000; 9: 573–583.

12. Ferreira S, Cruz DPD, Hughes GRV. Multiple sclerosis, neuropsychiatric lupus and antiphospholipid syndrom: where do we stand? Rheumatology 2005; 44: 434–442.

13. Mc Donald WI, Compston A, Edan G, et al. Recommeded Criteria for multiple sclerosis: guidelines from International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001; 50: 121–127.

14. Peterová V, Dostál C, Linková L, et al. The distribution of MR lesions in neuropsychiatrc lupus erythematosus and multiple sclerosis patients. Riv Neuroradiol 2003;16: 788–91.

15. Traboulsee AL, Li DK. The role of MRI in the diagnosis of multiple sclerosis. Adv Neurol 2006; 98: 125–146.

16. Rovaris M, Inglese M, Viti B, Ciboddo G. The contribution of fast FLAIR MRI for lesion detection in the brain of patients with systemic autoimmune disease. J Neurol 2000; 2347: 29–33.

17. Jensen MC. Brant-Zawadski MN, Jacobs BC. Ischemiea. In Mosby (Eds.): Magnetic resonance imaging of the brain and spine. USA 1999: 1255–1274.

18. Lee MA, Smith S, Palace J, et al. Spatial mapping of T2 and gadolinium-enhancing T1 lesion volumes in multiple sclerosis: evidence for distinct mechanisms of lesion genesis. Brain 1999; 122: 1261–1270.

19. Saindane AM, Ge BAY, Udupa JK, Babb JS, Mannon LJ, Grossman RI. The effect of gadolinium-enhancing lesions on whole brain atrophy in relapsing-remitting MS. Neurology 2000; 55: 61–65.

20. Saiz A, Carreras E, Berenguer J, Yague J, Martinez C. MRI and CSF oligoclonal bands after autologous hematopoetic stem cell transplantation in MS. Neurology 2001; 56: 1084–1089.

21. Scott RC, Gadian DG, Gross JH, Wood SJ, Neville BGR, Connely A. Quantitative magnetic resonance characterisation of mesial temporal sclerosis in childhood. Neurology 2001; 56: 1659–1665.

22. Tarkka R, Paakko E, Pyhtinen J, Uhari M, Rantala H. Febrile seizures and mesial temporal sclerosis. Neurology 2003; 60: 215–218.

23. Callen DJA, Black SE, Gao F, Caldwell CB, Szalain JP. Beyond the hippocampus. MRI volumetry confirms widespread limbic atrophy in AD. Neurology 2001; 57: 1669–1674.

24. Schocke MFH, Sepp K, Esterhammer R, et al. Diffusion-weighted MRI differentiates the Parkinson variant of multiple system atrophy from PD. Neurology 2002; 58: 575–580.

25. Bosma GP, Rood MJ, Huizinga TW, de Jong BA, Bollen EL, van Buchem MA. Detection of cerebral involvement i patients with active neuropsychiatric systemic lupus erythematosus by the use of volumetric magnetization transfer imaging. Arthritis Rheum 2000; 43(11): 2428–2436.

26. Bosma GP, Meddelkoop HA, Rood MJ, Bollen EL, Huizinga TW, van Buchem MA. Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus. Arthritis Rheum 2002; 46(10): 2665–2672.

27. Ainiala H, Dastidar P, Loukkola J, et al. Cerebral MRI abnormalities and their association with neuropsychiatric manifestations in SLE: a population based study. Scand J Rheumatol 2005; 34: 376–382.

28. Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH and the Committee on Prognosis Studies in SLE: Derivation of the SLEDAI: a disease activity index for lupus patients. Arthritis Rheum 1992; 35: 630–640.

29. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40(9): 1725.

30. Vaněčková M, Seidl Z, Krásenský J, et al. Nové trendy v zobrazování magnetickou rezonancí u roztroušené sklerózy mozkomíšní. Technika MR volumometrie vyvinutá a prováděná naším pracovištěm. Čes Radiolog 2002; 56(6): 327–330.

31. Brandt JT, Tripplett DA, Alving B, Scharrer I. Criteria for the diagnosis of lupus anticoagulants: an update. Thromb Heamost 1995; 74: 1185–90.

32. WilsonWA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999; 42: 1309–11.

33. Ainiala H, Hietaharju A, Loukkola J, et al. Validity of the new American College of Rheumatology criteria for neuropsychiatric lupus syndromes: a population-based evaluation. Arthritis Rheum 2001; 45: 419–423.

34. Sanna G, Berolaccini ML, Cuadrado MJ, et al. Neuropsychiatric manifesrations in systemic lupus erythematosus: prevalence and association with antiphospholipid antibodies. J Rheumatol 2003; 30: 985–992.

35. Hanly JG, McCurdy G, Fougere L, Douglas J-A, Thompson K. Neuropsychiatric events in Systemic Lupus Erythematosus (SLE): attribution and clinical significance. J Rheumatol 2004; 31 (11): 2156–2162.

36. Sibbitt WL Jr, Brooks WM, Haseler LJ, et al. Spin-spin relaxation of brain tissues in systemic lupus erythematosus: a method for increasing the sensitivity of magnetic resonance imaging for neuropsychiatric lupus. Arthritis Rheum 1995; 38: 810–818.

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

38. Taccari E, Scavalli AS, Spadaro A, et al. Magnetic resonance imaging (MRI) of the brain in SLE: ECLAM and SLEDAI correlations. Clin Exper Rheum 1994; 12: 23–28.

39. Bruce IN. Atherogenesis and autoimmune disease: the model of lupus. Lupus 2005; 14: 687–690.

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