Abstract
MRI and 2D-CSI spectroscopy were performed in eight patients with systemic lupus erythematosus who presented with acute onset of neuropsychiatric lupus (NP-SLE), and in seven normal controls to evaluate for differences in metabolic peaks and metabolic ratios between the two groups. Also, the interval change of the metabolic peaks and their ratios during treatment in the NP-SLE patient group was evaluated. Metabolic peaks for N-acetyl-aspartate (NAA), choline (Cho), creatine (Cr), and lactate/lipids (LL) and their ratios (NAA/Cr, NAA/Cho, Cho/Cr, LL/Cr) were determined at initial presentation and 3 and 6 months later. In the eight lupus patients compared to the seven normal controls, NAA/Cho ratios were lower at presentation (1.05 vs 1.25; p = 0.004) and decreased even further at the three month follow-up (0.92 vs 1.05; p = 0.008). In contrast, both Cho/Cr (1.42 vs 1.26; p = 0.026) and LL/Cr ratios (0.26 vs 0.19; p = 0.002) were higher in the lupus patients at presentation compared to the controls and did not significantly change at three and six months follow-up. The NAA/Cr ratios were lower in the lupus patients compared to the controls at presentation but the difference was not statistically significant. However, the mean NAA/Cr significantly decreased from the initial examination to the three month follow-up (1.42 vs 1.32; p = 0.049) but did not significantly change from the three to the six month follow-up examinations. The NAA/Cr, Cho/Cr, and NAA/Cho ratios varied significantly (p < 0.05, p < 0.05, p < 0.05, respectively) between the 17 different locations measured in the brain in all eight patients and seven controls. Both the NAA/Cr ratios and the Cho/Cr ratios were also significantly lower in the gray matter than in the white matter (p < 0.0001) in both patients and controls, whereas the LL/Cr and NAA/Cho ratios were not significantly different. In conclusion, 2D-CSI MR spectroscopy may be useful in the early detection of metabolic CNS changes in NP-SLE patients with acute onset of new neurological symptoms as well as in the follow-up after treatment to assess presence and changes in metabolic brain injury. However, although there are detectable differences between normal individuals and lupus patients it is currently unclear whether these relate to the acute episode. Future studies are needed comparing NP-SLE patients with active CNS involvement with those inactive disease.
Similar content being viewed by others
References
Kovacs J, Urowitz M, Gladman D (1993) Dilemmas in neuropsychiatric lupus. Rheum Dis Clin North Am 19:795–819
Denburg SD, Behmann SA, Carbotte RM, Denburg JA (1994) Lymphocyte antigens in neuropsychiatric systemic lupus erythematosus. Relationship of lymphocyte antibody specificities to clinical disease. Arthritis Rheum 37:369–375
ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature (1999) The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 42:599–608
Wasserman BA, Stone JH, Hellman DB, Pomper MG (2001) Reliability of normal findings on MR imaging for excluding the diagnosis of vasculitis of the central nervous system. Am J Roentgenol 177:455–459
Jennings JE, Sundgren PC, Attwood J, McCune J, Maly P (2004) Value of brain MRI in SLE patients presenting with neurologic symptoms. Neuroradiology 46:15–21
Pomper M, Miller T, Stone J, Tidmore W, Hellman D (1999) CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. Am J Neuroradiol 20:75–85
McCune J, MacGuire A, Aisen A, Gebarski S (1988) Identification of brain lesions in neuropsychiatric systemic lupus erythematosus by magnetic resonance scanning. Arthritis Rheum 31:159–166
Jacobs L, Kinkel P, Costello PB, Alukal MK, Kinkel WR, Green FA (1988) Central nervous system lupus erythematosus: the value of magnetic resonance imaging. J Rheumatol 15:601–606
Sibbitt WL Jr, Sibbitt RR, Griffey RH, Eckel C, Bankhurst AD (1989) Magnetic resonance and computed tomographic imaging in the evaluation of acute neuropsychiatric disease in systemic lupus erythematosus. Ann Rheum Dis 12:1014–1022
Lim MK, Suh CH, Kim HJ, Cho YK, Choi SH, Kang JH, Park W, Lee JH (2000) Systemic lupus erythematosus: brain MR imaging and single-voxel hydrogen1 MR spectroscopy. Radiology 217:43–49
Axford JS, Howe FA, Heron C, Griffiths JR (2001) Sensitivity of quantitative 1H magnetic resonance spectroscopy of the brain in detecting early neuronal damage in systemic lupus erythematosus. Ann Rheum Dis 60:106–111
Sibbitt WL Jr, Haseler LJ, Griffey RR, Friedman SD, Brooks WM (1997) Neurometabolism of active neuropsychiatric lupus determined with proton MR spectroscopy. Am J Neuroradiol 18:1271–1277
Brooks WM, Sabet A, Sibbitt WL Jr, Barker PB, van Zijl PCM, Duyn JH, Moonen CTW (1997) Neurochemistry of brain lesions determined by spectroscopic imaging in systemic lupus erythematosus. J Rheumatol 24:2323–2329
Chinn RJS, Wilkinson ID, Hall-Craggs MA, Paley MNJ, Shorthall E, Carter S, Kendall BE, Issenburg DA, Newman SP, Harrison MJG (1997) Magnetic resonance imaging of the brain and cerebral proton spectroscopy in patients with systemic lupus erythematosus. Arthritis Rheum 40:36–46
Friedman SD, Stidley CA, Brooks WM, Hart BL, Sibbitt WL Jr (1998) Brain injury and neurometabolic abnormalities in systemic lupus erythematosus. Radiology 209:79–84
Provenzale JM, Barboriak DP, Allen NB, Ortel TL (1996) Patients with antiphospholipid antibodies: CT and MR findings of the brain. Am J Roentgenol 167:1573–1578
Provenzale JM, Barboriak DP, Allen NB, Ortel TL (1998) Antiphospholipid antibodies: findings at arteriography. Am J Neuroradiol 19:611–616
Karassa FB, Ioannidis JP, Boki KA et al (2000) Predictors of clinical outcome and radiologic progression in patients with neuropsychiatric manifestations of systemic lupus erythematosus. Am J Med 109:628–634
Sabet A, Sibbitt WM Jr, Stidley CA, Danska J, Brooks WM (1998) Neurometabolite markers of cerebral injury in the antiphospolipid antibody syndrome of systemic lupus erythematosus. Stroke 29:2254–2260
Manthorpe R, Manthorpe T, Sjoberg S (1992) Magnetic resonance imaging of the brain in patients with primary Sjogrens’s syndrome. Scand J Rheumatol 21:148–149
Provencher SW (1993) Estimation of metabolite concentrations from localized in vivo proton NMR spectra. Mag Reson Med 30(6):672–679
Acknowledgement
This study has, in part, been supported by Department of Radiology Seed Grant, #U008039, University of Michigan, Ann Arbor, MI, USA and the Berlex Foundation, USA Grant # U012695.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sundgren, P., Jennings, J., Attwood, J. et al. MRI and 2D-CSI MR spectroscopy of the brain in the evaluation of patients with acute onset of neuropsychiatric systemic lupus erythematosus. Neuroradiology 47, 576–585 (2005). https://doi.org/10.1007/s00234-005-1371-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-005-1371-y