Clinical Explore Of ~1H MRS In The Evaluation Of The Neuropsychiatric Systemic Lupus Erythematosus

Objective: To determine whether brain lesions exist in the patients of neuropsychiatric systemic lupus erythematosus by the ~1H magnetic resonance spectroscopy and the relationship between them and the systemic lupus erythematosus disease activity index. To evaluate the usefulness of ~1H magnetic resonance spectroscopy in diagnosing patients of neuropsychiatric systemic lupus erythematosus and clinical usefulness of ~1H magnetic resonance spectroscopy in grading the neuropsychiatric manifestations of neuropsychiatric systemic lupus erythematosus.Materials and methods: Twenty patients of NPSLE and twenty controls were examined with ~1H multi-voxel spectrocsopy. The voxel of nineneen patients of NPSLE and controls were placed in the normal frontal and parietal deep white matter, one patient was placed in the abnormal frontal and parietal deep white matter. Patients were classified as having major NPSLE(n=12, including one patient voxel was placed in the abnormal frontal and parietal deep white matter ) and minor NPSLE(n=8). Fifteen patients of NPSLE and 17 controls were examined with ~1H multi-voxel spectrocsopy. The voxel was placed in the basal ganglia, which was normal by conventional magnetic resonance imaging. Fifteen patients of NPSLE were classified as having major NPSLE(n=9) and minor NPSLE(n=6). Concentrations of NAA, Cr and Cho were measured. The ratios of NAA/Cr, Cho/ Cr and NAA/ Cho were calculated. The systemic lupus erythematosus disease activity indexes of all patients of NPSLE, the major NPSLE and the minor NPSLE were measured. Both the values of metabolite ratios and the systemic lupus erythematosus disease activity index scores were compared between patients of NPSLE and controls, the major NPSLE and the minor NPSLE. The relationship of the ratios of metabolites and the systemic lupus erythematosus disease activity index score was analysed. The values of metabolite ratios of positive and negative MRI manifestations were compared .Independent samples t-test was used for the comparison of two samples. Two-two comparisons of many samples applied ANOVA and Kruskal-Wallis H meathod.Results: ~1H MRS can find abnormal metabolites in all patients of NPSLE, in which decrease of NAA /Cr was most common (P<0. 05) . The decrease of the ratio of NAA /Cr and NAA/ Cho in the basal ganglia and normal frontal and parietal deep white matter in the patients of NPSLE is more than that of the controls (P<0. 05) and that this abnormal metabolite in the parietal deep white matter is most significant(P<0. 001). The decrease of the ratios of NAA /Cr of the normal parietal deep white matter in the patients of the major NPSLE is more than that of the minor NPSLE (P<0. 05) . The increase of ratios of the Cho/Cr of the basal ganglia in the patients of the major NPSLE is more than that of the minor NPSLE (P>0. 05) .Fourteen of 20 patients had positive MRI manifestation (70%) and six had negative MRI manifestation (30%). The decrease of the ratios of NAA/Cr of the normal frontal and parietal deep white matter in the patients of the positive MRI manifestation is more than that of negative MRI manifestation (the former P<0. 05, the latter P>0. 05) . The ratios of NAA/Cr of normal frontal and parietal deep white matter of one major NPSLE increased and the ratios of NAA/Cr of frontal lobe was in the normal range when one month checked again. The ratios of NAA/Cr and NAA/Cho decreased significantly and Cho/Cr increased significantly in the foci of the frontal and parietal deep white matter in another patient of major NPSLE. The scores of the systemic lupus erythematosus disease activity index in the patients of the major NPSLE was more than that of the minor NPSLE (P <0.05) .Conclusions: The decrease of the ratios of NAA /Cr of the basal ganglia and normal frontal and parietal deep white matter examined by conventional magnetic resonance imaging in patients of NPSLE indicates that microcosmic brain lesions exist and whether they are partially reversible needs to more study. The decrease of the ratios of NAA /Cr of the normal parietal deep white matter, the increase of ratios of the Cho/Cr of the basal ganglia and scores of the systemic lupus erythematosus disease activity index in the patients of the major NPSLE is more than that of the minor NPSLE and the decrease of the ratios of NAA /Cr of the normal frontal and parietal deep white matter in the patients of the positive MRI manifestation is more than that of negative MRI manifestation indicates that the results of ~1H MRS can reflect the severity of NPSLE. The results of ~1H MRS has some relationship with the disease activity of NPSLE.