Abstract
To determine whether any brain MR abnormalities, including enlarged perivascular spaces (EPVS), were associated with disease activity in systemic lupus erythematosus (SLE) as an inflammatory activity. One hundred and thirty SLE patients with normal MR findings were assessed. With regard to MRI abnormalities, patients with brain atrophy and mild white matter hyperintensity (WMH) on T2WI were not excluded. The disease activity was assessed using the SLEDAI and the BILAG scores. The imaging characteristics included centrum semiovale EPVS (CS- EPVS) and basal ganglia EPVS on T2WI, WMH, and brain atrophy. We used univariate and multivariate logistic regression analyses to determine the clinical (vascular risk factors and blood examinations) and imaging characteristics that were associated with the disease activity of SLE. High CS-EPVS to be the only factor that was independently associated with the severity of the SLEDAI and BILAG scores (odds ratio [OR] 5.77; 95% confidence interval [CI] 2.21–15.00; p < 0.001 for the SLEDAI, and OR 2.64; 95% CI 1.03–6.74; p = 0.042 for the BILAG score). The CS-EPVS in the SLE patients are associated with the systemic disease activity, suggesting that CS- EPVS may be indicative of the reactive changes of the white matter due to the inflammatory activity.
Highlights
Systemic lupus erythematosus (SLE) is an autoimmune disease that frequently manifests with central nervous system (CNS) involvement[1,2]
These findings suggest that perivascular spaces (PVSs) are sites in which inflammatory activity is triggered in the CNS, and that Enlarged PVSs (EPVS) may play a role in the onset of neuroinflammatory activity
The novel finding in this study is that the number of semiovale EPVS, as measured by MRI in a large sample of 130 systemic lupus erythematosus (SLE) patients, was independently and significantly associated with disease activity (SLEDAI and British Isles Lupus Assessment Group 2004 (BILAG) scores) – which is consistent with the hypothesis that EPVS are related to neuroinflammatory activity
Summary
Systemic lupus erythematosus (SLE) is an autoimmune disease that frequently manifests with central nervous system (CNS) involvement[1,2]. Many MRI studies have supplied ample evidence of brain pathology in SLE patients, such as cerebral infarction, brain atrophy and multifocal gray matter (GM) and/or white matter (WM) lesions[4] These MR findings may indicate that the pathological conditions of the brain occur as a result of SLE-related inflammation. In previous MRI studies[6,7,8], EPVS are observed in various inflammatory disorders, including multiple sclerosis (a chronic inflammatory disease of the CNS), and experimental autoimmune encephalomyelitis These findings suggest that PVS are sites in which inflammatory activity is triggered in the CNS, and that EPVS may play a role in the onset of neuroinflammatory activity. The purpose of this study was to determine whether any MR abnormalities, including EPVS, were associated with the disease activity in SLE as an inflammatory activity
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