Structural and atrophic changes in the brain in patients with systemic lupus erythematosus

September 30, 2021
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Abstract. Systemic lupus erythematosus (SLE) is a chronic disease of autoimmune-inflammatory origin occurring with the involvement of many organ systems. One of the typical manifestations is neuropsychiatric SLE — a complex of neurological and mental disorders that arise in patients with this disease. Aim: to study the characteristics of morphological disorders of the brain in patients with SLE. Object and research methods. The object of the study was radiological findings, in particular atrophic phenomena, of the brain in patients with SLE. All patients underwent neuroimaging examinations — magnetic resonance imaging (MRI) of the brain on an apparatus with a field induction of 1.5 T. This examination included a visual qualitative assessment of tomograms in order to identify structural abnormalities. To assess atrophic phenomena, the morphometric indices were calculated, which represent the relative values of the volume of the brain parenchyma in a particular area, — FFR, SFR, BFR and BCR. Results. During MRI, only one patient in group 2 was found to have changes, namely the expansion of cerebrospinal fluid spaces, while in 34 (62.9%) patients of the main group, these disorders were identified (p=0.002). Also in 7 (12.9%) patients in group 1, post-stroke cysts were found, leukoaraiosis (p=0.006) in 25 (46.3%), and demyelinating processes in 8 (14.8%). Average levels of morphometric indices of brain atrophy in examined patients with SLE ranged from 0.055 (0.034; 0.061) — FFR to 0.304 (0.282; 0.318) — BFR. For all indices of brain atrophy, statistically significant differences between the study groups were determined according to statistically significantly higher (p<0.001) mean values in patients of group 1, compared to group 2. Conclusions. In the structure of morphological changes detected on MRI of the brain in patients with SLE, nonspecific findings dominate: atrophic phenomena, leukoaraiosis and expansion of cerebrospinal fluid spaces. The prevalence of radiological findings on MRI of the brain in patients with SLE with neurological manifestations is significantly higher than in patients with SLE without neurological manifestations. The severity of cortex and subcortical atrophy in patients with neuropsychiatric SLE is significantly higher than in patients without neurological manifestations in all morphometric indices.

References:

  • 1. Makarov S.O. (2018) Nervous system impairment under systemic lupus erythematosus: pathogenesis aspects, prevalence and viewson clinical manifestations classification. Ukr. Neurol. J., 2: 25–29. DOI: 10.30978/UNZ2018225.
  • 2. Fava A., Petri M. (2019) Systemic lupus erythematosus: diagnosis and clinical management. J. Autoimmun., 96: 1–13. DOI: 10.1016/j.jaut.2018.11.001.
  • 3. Liang M.H., Corzillius M., Bae S.C. et al. (1999) The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis rheum., 42(4): 599–608.
  • 4. Makarov S.O. (2021) Structure of neurological manifestations in patients with systemic lupus erythematosus. Bull. Probl. Biol. Med., 159(2): 90–93. DOI:10.29254/2077-4214-2021-1-159-90-93.
  • 5. Bertsias G.K., Ioannidis J.P.A., Aringer M. et al. (2010) EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann. Rheum. Dis., 69(12): 2074–2082. DOI: 10.1136/ard.2007.070367.
  • 6. Csépány T., Bereczki D., Kollár J. et al. (2003) MRI findings in central nervous system systemic lupus erythematosus are associated with immunoserological parameters and hypertension. J. Neurol., 250(11): 1348–1354. DOI: 10.1007/s00415-003-0223-0.
  • 7. Toledano P., Sarbu N., Espinosa G. et al. (2013) Neuropsychiatric systemic lupus erythematosus: magnetic resonance imaging findings and correlation with clinical and immunological features. Autoimmun. Rev., 12(12): 1166–1170. DOI: 10.1016/j.autrev.2013.07.004.
  • 8. Sarbu N., Bargalló N., Cervera R. (2015) Advanced and conventional magnetic resonance imaging in neuropsychiatric lupus. F1000Res., 4: 162.
  • 9. Sarbu N., Alobeidi F., Toledano P. et al. (2015) Brain abnormalities in newly diagnosed neuropsychiatric lupus: systematic MRI approach and correlation with clinical and laboratory data in a large multicenter cohort. Autoimmun. Rev., 14(2): 153–159. DOI: 10.1016/j.autrev.2014.11.001.
  • 10. Steup-Beekman G.M., Zirkzee E.J., Cohen D. et al. (2013) Neuropsychiatric manifestations in patients with systemic lupus erythematosus: epidemiology and radiology pointing to an immune-mediated cause. Ann. Rheum. Dis., 72 (Suppl. 2): ii76–ii79. DOI: 10.1136/annrheumdis-2012-202369.
  • 11. Luyendijk J., Steens S.C.A., Ouwendijk W.J.N. et al. (2011) Neuropsychiatric systemic lupus erythematosus: lessons learned from magnetic resonance imaging. Arthritis Rheum., 63(3): 722–732. DOI: 10.1002/art.30157.
  • 12. Gomori J.M., Steiner I., Melamed E., Cooper G. (1984) The assessment of changes in brain volume using combined linear measurements. Neuroradiology, 26(1): 21–24. DOI: 10.1007/BF00328197.