White Matter Magnetization Transfer Ratio Histogram Peak Height Helps Identifying Inflammatory Neuropsychiatric Systemic Lupus Erythematosus

César Magro Checa¹, Ece Ercan², Bart J Emmer³, Ron Wolterbeek⁴, Itamar Ronen², Mark A. Van Buchem², T. W. J. Huizinga⁵ and Gerda M. Steup-Beekman⁵, ¹Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²Radiology, C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands, ³Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands, ⁴Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands, ⁵Rheumatology, Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Magnetic resonance imaging (MRI), Neuroimaging, neuropsychiatric disorders, phenotypes and systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, November 10, 2015

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment V: Neuropsychiatric Lupus

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Magnetization
transfer ratio (MTR) can be used to detect microstructural cerebral changes in
normal-appearing brain tissue of neuropsychiatric systemic lupus erythematosus
(NPSLE) patients. Our aim was to assess white matter (WM) and grey matter (GM)
magnetization transfer ratio histogram peak heights (MTR-HPHs) in different
subsets of NPSLE patients with a non-remarkable 3T-brain-MRI and to evaluate
whether these values could highlight different clinically suspected underlying
pathogenic processes, recognize the clinical NPSLE status or be associated with
a specific NPSLE syndrome.

Methods: Sixty-four
SLE-patients with neuropsychiatric symptoms were included. The initial NPSLE
diagnosis and suspected pathogenic underlying process were established by
multidisciplinary evaluation. Furthermore, we performed a re-evaluation of the
disease course and confirmation of the diagnosis 6-18 months later.
Thirty-three patients with central nervous system (CNS) NPSLE and 31 SLE
patients with neuropsychiatric complaints non-related to SLE (NP-non-SLE) were
included. Twenty SLE patients without neuropsychiatric complaints and 36
healthy controls were included for comparison. Differences of mean WM and GM
MTR-HPH values between different NPSLE subgroups (inflammatory or ischemic
NPSLE phenotype), the clinical changes after treatment and the relation with
NPSLE syndromes were evaluated.

Results: The mean and
standard deviation of the WM and GM MTR-HPHs are presented in Table 1. Inflammatory
NPSLE patients have significantly lower WM MTR-HPH than healthy controls (P
< 0.001), SLE (P < 0.001) and NP-non-SLE patients (P <
0.05) (Figure 1). Cognitive disorder, mood disorder and psychosis were related
to lower values and cerebrovascular symptoms to higher values of WM MTR-HPH (P
< 0.05). Furthermore, we show how the mean WM MTR-HPHs increased when the
clinical status of the NPSLE patients improved (P < 0.001) (Figure
1).

Conclusion: WM MTR-HPH has
potential to identify inflammatory NPSLE with CNS involvement corroborating the
usefulness of this technique to detect cerebral changes in NPSLE patients and
to assess clinical changes after treatment.

Table 1. Comparison of white matter and grey matter MTR-HPHs in the study groups
	Healthy controls (n=36)	SLE (n = 20)	NP-non-SLE (n = 31)
				Phenotype
				Inflammatory NPSLE (n=22)	Ischemic NPSLE (n = 11)
WM MTR-HPH µ	43.37 ± 5.11^†	42.74 ± 6.22^†	38.35 ± 4.64^‡	32.22 ± 7.76	39.42 ± 4.21^†
GM MTR-HPH µ	10.01 ± 2.51	10.02 ± 1.92^‡	9.81 ± 3.68	7.71 ± 3.25	10.25 ± 2.85
CNS: central nervous system; GM: grey matter; MTR-HPH: magnetization transfer ratio histogram peak height; NP-non-SLE: SLE patients with neuropsychiatric complaints non associated with CNS involvement due to SLE; NPSLE: neuropsychiatric SLE; SLE: systemic lupus erythematosus; WM: white matter. * Values are the mean ± standard deviation. † Indicates significance level at P < 0.001 when compared with inflammatory NPSLE ‡ Indicates significance level at P < 0.05 when compared with inflammatory NPSLE µ Peak height values were multiplied by 10,000 for readability.

Disclosure: C. Magro Checa, None; E. Ercan, None; B. J. Emmer, None; R. Wolterbeek, None; I. Ronen, None; M. A. Van Buchem, None; T. W. J. Huizinga, None; G. M. Steup-Beekman, None.

To cite this abstract in AMA style:

Magro Checa C, Ercan E, Emmer BJ, Wolterbeek R, Ronen I, Van Buchem MA, Huizinga TWJ, Steup-Beekman GM. White Matter Magnetization Transfer Ratio Histogram Peak Height Helps Identifying Inflammatory Neuropsychiatric Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/white-matter-magnetization-transfer-ratio-histogram-peak-height-helps-identifying-inflammatory-neuropsychiatric-systemic-lupus-erythematosus/. Accessed .

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