Background/Purpose: The pathogenesis of neuropsychiatric SLE (NPSLE) has not been fully elucidated. Recent evidence suggests impaired blood brain barrier (BBB) integrity as a possible mechanism leading to neuropsychiatric damage. We aimed to assess brain imaging patterns in patients with SLE, NPSLE and healthy controls utilizing multi-parametric MRI methods to assess cerebral atrophy, tissue and BBB integrity. We also aimed to assess correlations between imaging findings, clinical characteristics and cognition.

Methods: Twenty-three consecutive patients attending the Lupus clinic (NPSLE n=11, non-NPSLE n=12), and 20 age and gender matched healthy subjects were recruited. The MRI protocol included high-resolution T1 sequence (MP2RAGE), diffusion tensor imaging and dynamic contrast enhanced imaging utilizing a 3-Tesla MRI scanner. Brain segmentation was performed to assess volumetric changes, tissue integrity and BBB permeability in various brain regions. Clinical parameters, quality of life and cognition were assessed. Patients were divided into subgroups based on presence of NPSLE, SLE disease activity, disease duration, accrued damage and presence of antiphospholipid antibodies (aPL). Comparisons were performed between the entire patient group and the control group and between subgroups.

Results: The NPSLE group was significantly younger than the non-NPSLE group and significantly less educated compared to the healthy controls and the non-NPSLE group. The NPSLE group had significantly shorter disease duration, more accrued damage, more hypertension compared to the non-NPSLE group and a higher percentage were treated with anticoagulants.

Abnormal findings on conventional MRI (cMRI) were seen in 67% of the non-NPSLE group and 82% of the NPSLE group. Brain atrophy was seen in 43% of the patients and was not limited to NPSLE. In the NPSLE group a negative correlation was observed between the volume of grey matter and disease duration. The grey matter volume was significantly reduced in the NPSLE group and in patients with aPL as compared to healthy controls. The volume of the nucleus accumbens was significantly reduced in patients with a damage index of < 1 as compared to those without damage and compared to healthy controls. Impairment of BBB integrity, as expressed by increased permeability values compared to healthy controls was seen in 5 of the SLE patients (25%), 3 of whom were non-NPSLE. Increased permeability was detected in several cerebral grey and white matter regions. All 5 patients had significantly longer disease duration ( >10years) and as a group had a smaller volume of the anterior segment of the corpus callosum. One patient with SLE underwent MRI scanning during active disease and repeat scan when the disease was better controlled showing a reduction in BBB permeability by 25% in 8 brain regions.

Conclusion: In the present study we detected abnormal cMRI findings, brain atrophy and impaired BBB integrity among patients with SLE, which was not limited to patients with NPSLE. Our results suggest that impairment of the BBB occurs in patients with long disease duration and possibly during active disease, even in patients with SLE without overt NPSLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/blood-brain-barrier-integrity-and-brain-imaging-patterns-in-patients-with-sle/