The Neurochemical and Microstructural Changes in the Brain of Systemic Lupus Erythematosus Patients: A Multimodal MRI Study.

Xiaofang Cheng,Gen Yan,Zhongxian Yang,Yukai Wang,Renhua Wu,Li Li,Yuanyu Shen,Dongxiao Chen,Zhiyan Zhang,Zhiwei Shen,Xiangyong Tang,Wei Hu

doi:10.1038/srep19026

Abstract

The diagnosis and pathology of neuropsychiatric systemic lupus erythematosus (NPSLE) remains challenging. Herein, we used multimodal imaging to assess anatomical and functional changes in brains of SLE patients instead of a single MRI approach generally used in previous studies. Twenty-two NPSLE patients, 21 non-NPSLE patients and 20 healthy controls (HCs) underwent 3.0 T MRI with multivoxel magnetic resonance spectroscopy, T1-weighted volumetric images for voxel based morphometry (VBM) and diffusional kurtosis imaging (DKI) scans. While there were findings in other basal ganglia regions, the most consistent findings were observed in the posterior cingulate gyrus (PCG). The reduction of multiple metabolite concentration was observed in the PCG in the two patient groups, and the NPSLE patients were more prominent. The two patient groups displayed lower diffusional kurtosis (MK) values in the bilateral PCG compared with HCs (p < 0.01) as assessed by DKI. Grey matter reduction in the PCG was observed in the NPSLE group using VBM. Positive correlations among cognitive function scores and imaging metrics in bilateral PCG were detected. Multimodal imaging is useful for evaluating SLE subjects and potentially determining disease pathology. Impairments of cognitive function in SLE patients may be interpreted by metabolic and microstructural changes in the PCG.

Highlights

Magnetic resonance imaging (MRI) is the best imaging technique for the non-invasive diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE), even though a wide range of nonspecific abnormalities have been reported[4,5]
We evaluated MR images of NPSLE and non-NPSLE patients to examine the volume changes in grey matter using the Voxel-based morphometry (VBM) technique with statistical parametric mapping (SPM8) and diffeomorphic anatomical registration through exponentiated Lie algebra (DARTEL), which provides more accurate segmentation and registration compared with conventional VBM20
Compared with healthy controls (HCs), we found that the NAA level decreased in several regions according to multiple volume of interest comparisons, which included the bilateral posterior cingulate gyrus (PCG), DT and LLN in NPSLE patients as well as the LLN in non-NPSLE patients

Summary

Introduction

Magnetic resonance imaging (MRI) is the best imaging technique for the non-invasive diagnosis of NPSLE, even though a wide range of nonspecific abnormalities have been reported[4,5]. Magnetic resonance spectroscopy (MRS) of the human brain in vivo allows for non-invasive quantification of biological compounds, such as N-acetylaspartate (NAA), myoinositol (MI), choline-containing compounds (Cho), total creatine (tCr), glutamine (Gln) and glutamate (Glu) It has been widely used in SLE studies to gain insight into the pathology of grey matter (GM) and white matter damage[7,8,9,10]. Until now, few studies have used this automated whole-brain analysis method to investigate changes in brain morphology in SLE patients with and without neuropsychiatric symptoms, showing atrophy in specific regions compared with healthy controls[22,23,24,25] Results from these studies have not always been consistent. We seek the most clinically useful imaging methods that can distinguish SLE patients with CNS lesions from those without CNS lesions

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