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Brain MRI in neuropsychiatric lupus: associations with the 1999 ACR case definitions

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Abstract

The purpose of this study was to identify the characteristic magnetic resonance imaging (MRI) findings in neuropsychiatric systemic lupus erythematosus (NPSLE) and to investigate the association between MRI findings and neuropsychiatric manifestations in SLE. Brain MRIs with a diagnosis of SLE from 2002 to 2013 from three tertiary university hospitals were screened. All clinical manifestations evaluated by brain MRI were retrospectively reviewed. If the clinical manifestations were compatible with the 1999 NPSLE American College of Rheumatology (ACR) nomenclature and case definitions, the brain MRIs were assessed for the presence of white matter hyperintensities, gray matter hyperintensities, parenchymal defects, atrophy, enhancement, and abnormalities in diffusion-weighted images (DWI). The number, size, and location of each lesion were evaluated. The neuropsychiatric manifestation of each brain MRI was classified according to the 1999 ACR NPSLE case definitions. The associations between MRI findings and NPSLE manifestations were examined. In total, 219 brain MRIs with a diagnosis of SLE were screened, and 133 brain MRIs met the inclusion criteria for NPSLE. The most common MRI abnormality was white matter hyperintensities, which were observed in 76 MRIs (57.1 %). Gray matter hyperintensities were observed in 41 MRIs (30.8 %). Parenchymal defects were found in 31 MRIs (23.3 %), and atrophy was detected in 20 MRIs (15.0 %). Patients who had seizures were more associated with gray matter hyperintensities than patients with other neuropsychiatric manifestations. Patients with cerebrovascular disease were more associated with gray matter hyperintensity, parenchymal defects, and abnormal DWI than patients with other neuropsychiatric manifestations. In addition to white matter hyperintensities, which were previously known as SLE findings, we also noted the presence of gray matter hyperintensities, parenchymal defects, and abnormal DWI in a substantial portion of SLE patients, particularly in those with cerebrovascular disease or seizures.

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Acknowledgments

This work was supported by a 2013 Inje University research grant (M. Her).

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, Busan, South Korea

    Hae Woong Jeong

  2. Division of Rheumatology, Department of Internal Medicine, Busan Paik Hospital, Inje University, Gaegum-Dong, Busanjin-Gu, Busan, 614-735, South Korea

    Minyoung Her, Dongyook Kim & Nayoung Park

  3. Department of Neurology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea

    Jong Seok Bae

  4. Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, South Korea

    Seong-Kyu Kim & Jung-Yoon Choe

  5. Division of Rheumatology, Department of Internal Medicine, College of Medicine, Dong-A University, Busan, South Korea

    Sung Won Lee, Won Tae Chung & Sang Yeob Lee

  6. Department of Radiology, Catholic University of Daegu School of Medicine, Daegu, South Korea

    Ho Kyun Kim

  7. Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea

    In Joo Kim

Authors
  1. Hae Woong Jeong
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  2. Minyoung Her
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  3. Jong Seok Bae
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  5. Sung Won Lee
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  7. Dongyook Kim
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  8. Nayoung Park
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  9. Won Tae Chung
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  10. Sang Yeob Lee
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  11. Jung-Yoon Choe
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  12. In Joo Kim
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Corresponding author

Correspondence to Minyoung Her.

Additional information

Hae Woong Jeong and Minyoung Her have equally contributed to this study as first authors.

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Jeong, H.W., Her, M., Bae, J.S. et al. Brain MRI in neuropsychiatric lupus: associations with the 1999 ACR case definitions. Rheumatol Int 35, 861–869 (2015). https://doi.org/10.1007/s00296-014-3150-8

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  • DOI: https://doi.org/10.1007/s00296-014-3150-8

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