Longitudinal changes in cerebral white matter microstructure in newly diagnosed systemic lupus erythematosus patients

Lara D. Veeken, vol. 60, pp. 2678–2687

Abstract

OBJECTIVES: To evaluate longitudinal variations in diffusion tensor imaging (DTI) metrics of different white matter (WM) tracts of newly diagnosed SLE patients, and to assess whether DTI changes relate to changes in clinical characteristics over time. METHODS: A total of 17 newly diagnosed SLE patients (19-55 years) were assessed within 24 months from diagnosis with brain MRI (1.5 T Philips Achieva) at baseline, and after at least 12 months. Fractional anisotropy, mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity values were calculated in several normal-appearing WM tracts. Longitudinal variations in DTI metrics were analysed by repeated measures analysis of variance. DTI changes were separately assessed for 21 WM tracts. Associations between longitudinal alterations of DTI metrics and clinical variables (SLEDAI-2K, complement levels, glucocorticoid dosage) were evaluated using adjusted Spearman correlation analysis. RESULTS: Mean MD and RD values from the normal-appearing WM significantly increased over time (P = 0.019 and P = 0.021, respectively). A significant increase in RD (P = 0.005) and MD (P = 0.012) was found in the left posterior limb of the internal capsule; RD significantly increased in the left retro-lenticular part of the internal capsule (P = 0.013), and fractional anisotropy significantly decreased in the left corticospinal tract (P = 0.029). No significant correlation was found between the longitudinal change in DTI metrics and the change in clinical measures. CONCLUSION: Increase in diffusivity, reflecting a compromised WM tissue microstructure, starts in initial phases of the SLE disease course, even in the absence of overt neuropsychiatric (NP) symptoms. These results indicate the importance of monitoring NP involvement in SLE, even shortly after diagnosis.

Authors 14

1. Ettore Silvagni corresponding

   University of Ferrara · Arcispedale Sant'Anna

   Affiliation as printed

   Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy

2. Francesca Inglese Aachen Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

3. Alessandra Bortoluzzi

   University of Ferrara · Arcispedale Sant'Anna

   Affiliation as printed

   Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy

4. Massimo Borrelli

   Arcispedale Sant'Anna

   Affiliation as printed

   Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Sant’Anna, Cona (Ferrara), Italy

   Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Sant'Anna, Cona (Ferrara), Italy

5. Jelle J. Goeman Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

6. Alfredo Revenaz

   Arcispedale Sant'Anna

   Affiliation as printed

   Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Sant’Anna, Cona (Ferrara), Italy

   Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Sant'Anna, Cona (Ferrara), Italy

7. Elisabetta Groppo

   Ospedale San Paolo

   Affiliation as printed

   Neurological Clinic, University Hospital San Paolo, Milan, Italy

8. Gerda M. Steup‐Beekman Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands

9. Tom W. J. Huizinga Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands

10. Itamar Ronen Aachen Department of Radiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

11. Jeroen de Bresser Aachen Department of Radiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

12. Enrico Fainardi

    University of Florence

    Affiliation as printed

    Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy

13. Marcello Govoni

    University of Ferrara · Arcispedale Sant'Anna

    Affiliation as printed

    Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy

14. Ece Ercan Aachen Department of Radiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands