Background/Purpose: Antiphosholipid antibodies, SLICC-DI and some cardiovascular risk factors have been identified as risk factors for neuropsychiatric lupus (NPSLE). Diffusion tensor imaging (DTI) is an advanced MRI technique with an increased accuracy compared to conventional MRI (cMRI) in evaluating white matter microstructure. Our purpose was to assess the main factors affecting early SNC damage detected through DTI in SLE.

Methods: 20 consecutive SLE patients underwent a clinical evaluation to characterize CNS involvement (NPSLE) including: clinical hystory, a neuropsychological battery and pychiatric tests (HADS). All the patients and 14 healthy controls underwent MRI examination on a 1.5T magnet with a standard protocol for cMRI and DTI sequences. Region of interest (ROI) were placed symmetrically on normal appearing white matter (NAWM) in 12 areas (frontal and parietal WM, amygdala, corpus callosum, middle cerebellar peduncles). Mean diffusivity (MD) and fractional anisotropy (FA) were calculated bilaterally. ROI  relevant to distinguish patients with NPSLE  vs patients without and controls were selected on the basis of the receiver operating characteristic (ROC) curve analysis. SLEDAI, SLICC-DI, generic cardiovascular risk factors, positivity for Raynaud’s phenomenon, livaedo reticularis, cutaneous vasculitis, aPL, anti-RNP and anti-DNA were determined for all the patients and included as independent variables in several stepwise regression analysis to determine which of them affected changes in FA/MD in NAWM in an independent way.

Results: Measures of MD at the level of frontal right WM, corpus callosum and right middle cerebellar peduncle and of FA in left middle cerebellar peduncle showed moderate accuracy (AUC>0,71) in distinguishing SLE patients  and healthy controls, while MD and FA of right corpus callosum and FA in right amygdala in differentiating patients with and without NPSLE, according to the clinical classification (AUC>0.73). Among cardiovascular risk factors, diabetes, smoking and hypertension resulted as independent factors affecting MD and FA in corpo callosum bilaterally; hypertension was associated also to changes in FA and MD of amygdala. Among SLE-related factors, aPL, anti-DNA and SLEDAI were independent factors affecting FA of corpus callosum; aPL were associated also to changing in FA of fronto-parietal WM  while SLICC-DI to modifications of FA in amygdala. Finally cutaneous vasculitis  resulted as an independent factor affecting MD in corpus callosum.

Conclusion: This preliminary analysis showed as some cardiovascular risk factors (smoking, hypertension, diabetes), and some SLE-related factors (aPL, anti-DNA, SLEDAI, SLICC-DI, cutaneous vasculitis), previously reported as related to NPSLE, are associated to changes of  FA  and MD in normal appearing white matter of fronto-parietal lobes, corpus callosum and amygdala. These data, if confirmed, suggest a probable multifactorial pathogenesis of white matter abnormalities in SLE and underlie the possible role of DTI in detecting early SNC damage

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-associated-with-early-central-nervous-system-damage-detected-through-diffusion-tensor-imaging-dti-in-patients-with-systemic-lupus-erythematosus/