Diffusion tensor imaging in patients with obstetric antiphospholipid syndrome without neuropsychiatric symptoms
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To evaluate white matter (WM) integrity in neurologically asymptomatic antiphospholipid syndrome (APS) using diffusion tensor imaging (DTI) in women with no thrombotic history but with pregnancy loss.
Imaging was performed with a 3 T scanner using structural MRI (T1-weighted, fluid attenuation inversion recovery [FLAIR]) and DTI sequences in 66 women with APS and a control group of 17 women. Women with APS were further categorized as positive for lupus anticoagulant (LA) and/or aβ2GPI-G antibodies (LA/aβ2GPI-G-positive, N = 29) or negative (LA/aβ2GPI-G-negative, N = 37) for both. Tract-based spatial statistics of standard DTI-based indices were compared among groups.
Women with APS had significantly lower fractional anisotropy (p < 0.05) associated with higher mean diffusivity and radial diffusivity compared to the control group. There was a stronger association of abnormal DTI features among women positive for LA and/or aβ2GPI-IgG antibodies than those who were negative.
DTI appears sensitive to subtle WM changes in women with APS with no thrombotic history but with pregnancy loss, compatible with alterations in axonal structure and in the myelin sheath. The preferential association of abnormal DTI features with the two most pathogenic aPLAbs reinforces the pathophysiological relevance of our findings.
• APS women exhibited lower FA and higher MD and RD than controls.
• WM impairments are more severe in patients with positive LA or aβ2GPI-IgG.
• An association exists between abnormal DTI features and LA or aβ2GPI-IgG positivity.
• Diffusion tensor imaging detects microstructural white matter abnormalities in APS women.
KeywordsDiffusion tensor imaging Magnetic resonance imaging White matter Antiphospholipid syndrome Pregnancy
Anti-β2-glycoprotein I antibodies
Central nervous system
Nîmes Obstetricians and Hematologists Antiphospholipid Syndrome
Analysis of Functional NeuroImages
Tract-based spatial statistics
Threshold-free cluster enhancement
The authors thank all the study participants who agreed to join us in this long-term NOHA (Nîmes Obstetricians and Haematologists Antiphospholipid) administrative region-hospital medical network) adventure. We are also grateful to the NOHA network of gynaecologists, obstetricians and general practitioners who actively contributed to the study. We also thank the research staff of the Delegation for Clinical Research and Innovation of the University Hospital of Nîmes for their active help and support (N. Best, S. Granier, B. Lafont, C. Masseguin, H. Obert, H. Léal, O. Albert).
The scientific guarantor of this publication is Dr. Fabricio R. Pereira. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Fabricio R. Pereira) has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, case–control study, performed at one institution.