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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple different organs, including the kidneys and central nervous system (CNS). Conventional radiological examinations in SLE patients include volumetric/ anatomical computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US). The utility of these modalities is limited, however, due to the complexity of the disease. Furthermore, standard CT and MRI contrast agents are contraindicated in patients with renal impairment. Various radiologic methods are currently being developed to improve disease characterization in patients with SLE beyond simple anatomical endpoints. Physiological non-contrast MRI protocols have been developed to assess tissue oxygenation, glomerular filtration, renal perfusion, interstitial diffusion, and inflammation-driven fibrosis in lupus nephritis (LN) patients. For neurological symptoms, vessel size imaging (VSI, an MRI approach utilizing T2-relaxing iron oxide nanoparticles) has shown promise as a diagnostic tool. Molecular imaging probes (mostly for MRI and nuclear medicine imaging) have also been developed for diagnosing SLE with high sensitivity, and for monitoring disease activity. This paper reviews the challenges in evaluating disease activity in patients with LN and neuropsychiatric systemic lupus erythematosus (NPSLE). We describe novel MRI and positron-emission tomography (PET) molecular imaging protocols using targeted iron oxide nanoparticles and radioactive ligands, respectively, for detection of SLE-associated inflammation.
Highlights
Patients who present with neuropsychiatric systemic lupus erythematosus (NPSLE) or lupus nephritis (LN) are frequently treated with potent immunosuppressive agents, and immunosuppression is usually continued for prolonged periods[15,16]
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect any organ throughout the body[1]
The treatment of SLE almost always employs immunomodulatory therapies that suppress this autoimmune response. Immunosuppressive drugs, such as cyclophosphamide and mycophenolate mofetil (MMF), reduce tissue inflammation and injury, and the mortality for patients with SLE has improved in recent decades[2,3]
Summary
Any reports and responses or comments on the article can be found at the end of the article. We have made minor text edits, and 1 new reference was added. This was a reference suggested by the reviewers. Because immunosuppressive drugs carry the risk of infection and other toxicities, the choice of treatment depends upon a patient’s specific manifestations. LN and NPSLE are two of the most severe manifestations of lupus[3,12,13,14]. Patients who present with NPSLE or LN are frequently treated with potent immunosuppressive agents, and immunosuppression is usually continued for prolonged periods[15,16]
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