Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Antiphospholipid antibodies (aPL), hypertension and accumulated damage (SLICC-DI) have been associated to the severity of cerebral MRI lesions and to cognitive deficits in SLE. Perfusion weighted MRI (PWI) is a sensitive technique that assess the capillary microcirculation and might allow to detect an early vascular damage, eventually preceding the appearance of structural damage in conventional MRI. The aim of this study was to determine the main factors affecting CNS damage detected through perfusion MRI in SLE.
Methods:
20 consecutive SLE patients underwent a clinical evaluation to characterize central nervous system involvement (NPSLE) including the clinical history, a 45-minutes neuropsychological battery and the Hospital Anxiety and Depression Scale (HADS). All the patients underwent MRI examination performed on a 1.5T magnet. In all of them conventional (cMRI) and dynamic susceptibility contrast (DSC) sequences were performed. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP) maps were reconstructed for 19 patients. Region of interest (ROI) were placed symmetrically on normal appearing white matter (NAWM) in 12 areas ( frontal and parietal WM, amygdala, corpus callosum and middle cerebellar peduncles). ROI relevant to distinguish patients with NPSLE vs patients without 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 CBF, CBV MTT and TTP of NAWM.
Results:
Measures of CBV of right frontal WM (sensitivity 83,3%, specificity 71,4%) and of MTT in left frontal (sensitivity 58,3%, specificity 100%) and parietal WM (sensitivity 66,6%, specificity 85,7%) showed moderate accuracy (AUC 0,72) in distinguishing patients with and without NPSLE, according to the clinical classification. Among generic cardiovascular risk factors, smoking resulted as an independent factor affecting CBF and CBV in frontal and parietal subcortical NAWM, while cholesterol and hypertension were independent variables associated to MTT respectively of the fronto-parietal NAWM and corpus callosum. Among SLE-related factors, aPL and livaedo reticularis were independent factors affecting MTT of corpus callosum. Finally SLICC-DI resulted as an independent factor affecting all the parameters of PWI in fronto-parietal NAWM and corpus callosum.
Conclusion:
This preliminary analysis showed as some cardiovascular risk factors, (smoking, hypertension, cholesterol levels), and some SLE-related factors (aPL, SLICC-DI, livaedo reticularis), previously reported as related to NPSLE, are associated to early changes of cerebral perfusion in fronto-parietal subcortical normal appearing white matter and corpus callosum . These data, if confirmed, suggest the importance of a tight control of cardiovascular risk factors, aPL and of the disease activity to prevent early central nervous system damage in SLE.
Disclosure:
P. Tomietto,
None;
F. Casagrande,
None;
M. Ukmar,
None;
L. Weis,
None;
P. Morassi,
None;
R. Moretti,
None;
G. Biolo,
None;
C. Giansante,
None;
M. A. Cova,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-associated-with-early-central-nervous-system-damage-detected-through-perfusion-mri-in-patients-with-systemic-lupus-erythematosus/