Brain Perfusion MRI Findings in Patients with Behcet’s Disease

Alpay Alkan,Nergiz Turan,Yelda Karincaoglu,Ercan Kocakoc,Suat Kamisli,Namik Oztanir,Metin Dogan,Asli Goktan

doi:10.1100/2012/261502

Alpay Alkan, Nergiz Turan + Show 6 more

Open Access

https://doi.org/10.1100/2012/261502

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Abstract

Objective. To search brain perfusion MRI (pMRI) changes in Behcet's disease (BD) with or without neurological involvement. Materials and Method. The pMRI were performed in 34 patients with BD and 16 healthy controls. Based on neurologic examination and post-contrast MRI, 12 patients were classified as Neuro-Behcet (group 1, NBD) and 22 patients as BD without neurological involvement (group 2). Mean transit time (MTT), time to peak (TTP), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) were obtained and compared to those of healthy control group (group 3). Results. There was a significant difference in the MTT and rCBF within the pons and parietal cortex in groups 1 and 2. rCBV increased in cerebral pedicle in group 1 compared with groups 2 and 3. In the temporal lobe white matter, prolonged MTT and decreased rCBF were found in groups 1 and 2. In the corpus striatum, internal capsule, and periventricular white matter, rCBF increased in group 1 compared with group 3 and decreased in groups 1 and 2. Conclusion. Brain pMRI is a very sensitive method to detect brain involvement in patients with BD and aids the clinical diagnosis of NBD, especially in patients with negative MRI findings.

Highlights

Behcet’s disease (BD) was first recognized as a clinical entity by the Turkish dermatologist Hulusi Behcet
The exact pathogenesis of the disease is still unknown; ; that is triggered by exogenous factors, with genetic components that predispose to the autoimmune vasculitis has been suggested [7]
According to the results of neurological examination and conventional MRI findings, patients were classified as Neuro-Behcet’s disease (NBD) and BD. 16 healthy volunteers were included as control group

Summary

Introduction

Behcet’s disease (BD) was first recognized as a clinical entity by the Turkish dermatologist Hulusi Behcet. It is a multisystemic, recurrent, inflammatory disorder and affects the central nervous system (CNS) [1]. Clinical manifestations related to CNS involvement are extremely variable and are not always recognized [2]. Brain involvement may be caused by either primary parenchymal lesions or vascular damage. Behcet’s disease can cause immunemediated vasculitis affecting small and large sized vessels. The parenchymal distribution of lesions, especially in mesodiencephalic junction, supports small vessel vasculitis involving mainly venules [8, 9]. Perivascular inflammation might be important to understanding the pathogenesis of NBD [10]. Intermittent acute perivascular inflammation might contribute to the destruction of CNS parenchyma leading to loss of neuronal functions [10]

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Conclusion