Relationship between cerebral microbleeds and white matter MR hyperintensities in systemic lupus erythematosus: a retrospective observational study

  • Hyunjung Yeoh
  • Ji Young Lee
  • Young-Jun Lee
  • Dong Woo Park
  • Tae Yoon Kim
  • Ga Young Ahn
  • Sang-Cheol Bae
  • Young Seo Kim
  • Hyun Young Kim
  • Chun K. Kim
  • Ji Young Kim
  • Haejin Kim
  • Ji Won Han
Diagnostic Neuroradiology



White matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are known to be associated with small vessel diseases (SVD) and neuroinflammation. The purpose was to investigate the relationship between CMBs and WMH in patients with systemic lupus erythematosus (SLE).


Thirty-one SLE patients with WMH and 27 SLE patients with normal brain MRI were compared. The presence, location, and grading of CMBs were assessed using susceptibility-weighted images. WMH volume was quantitatively measured. Clinical characteristics and serologic markers were compared. We also performed two separate subgroup analyses after (1) dividing WMH into inflammatory lesion vs. SVD subgroups and (2) dividing WMH into those with vs. without CMB subgroups.


The WMH group showed more frequent CMBs than the normal MR group (p < 0.001). The WMH group showed higher SLE disease activity index, longer disease duration, and a higher incidence of antiphospholipid syndrome than the normal MR group (p = 0.02, 0.04, and 0.04, respectively). There was a moderate correlation between WMH volume and CMB grading (r = 0.49, p = 0.006). Within the WMH group, the inflammatory lesion subgroup showed more frequent CMBs and larger WMH volume than the SVD subgroup (p < 0.001 and 0.02, respectively). The WMH with CMB subgroup had larger WMH volume than the WMH without CMB subgroup (p = 0.004).


In patients with SLE, CMBs could be related to large-volume WMH and inflammatory lesions. CMBs along with severe WMH could be used as an imaging biomarker of vasculitis in patients with SLE.


Systemic lupus erythematosus White matter Cerebral microbleeds Magnetic resonance imaging Susceptibility weighted imaging 



White matter hyperintensities


Cerebral microbleeds


Antiphospholipid syndrome


Systemic lupus erythematosus


SLE disease activity index


Small vessel disease


Neuropsychiatric systemic lupus erythematosus


Central nervous system


Compliance with ethical standards


This study was funded by a grant from the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (Grant no. HI09C1379 [A092077]).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hyunjung Yeoh
    • 1
  • Ji Young Lee
    • 1
  • Young-Jun Lee
    • 1
  • Dong Woo Park
    • 2
  • Tae Yoon Kim
    • 2
  • Ga Young Ahn
    • 3
  • Sang-Cheol Bae
    • 3
  • Young Seo Kim
    • 4
  • Hyun Young Kim
    • 4
  • Chun K. Kim
    • 5
  • Ji Young Kim
    • 6
  • Haejin Kim
    • 7
  • Ji Won Han
    • 7
  1. 1.Department of Radiology, Hanyang University HospitalHanyang University College of MedicineSeoulSouth Korea
  2. 2.Department of Radiology, Hanyang University Guri HospitalHanyang University College of MedicineGuriSouth Korea
  3. 3.Department of Rheumatology, Hanyang University HospitalHanyang University College of MedicineSeoulSouth Korea
  4. 4.Department of Neurology, Hanyang University HospitalHanyang University College of MedicineSeoulSouth Korea
  5. 5.Department of Nuclear Medicine, Hanyang University HospitalHanyang University College of MedicineSeoulSouth Korea
  6. 6.Department of Nuclear Medicine, Hanyang University Guri HospitalHanyang University College of MedicineGuriSouth Korea
  7. 7.Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamRepublic of Korea

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