MRI Combined With DWI And1H-MRS Assessment Of NPSLE

Objective systemic lupus erythematosus (SLE) involving the nervous or psychiatric system is called neuropsychiatric systemic lupus erythematosus (NPSLE).NPSLE in diagnosis and treatment have some difficulty,and lack of a single effective imaging examination tools,this paper is to explore the conventional magnetic resonance imaging (cMRI) combined the use of diffusion weighted imaging (DWI) and proton magnetic resonance spectroscopy (1H-MRS) to assess the application value in NPSLE.Materials and Methods26NPSLE patients,10common SLE patients and10healthy volunteers in advance underwent cMRI, DWI and MRS. the region of interest of MRS is chosen for deep brain white matter of forehead parietal lobe which is the normal area far from MRI lesions or MRI negative patients. We analysed conventional MRI, DWI and MRS characteristics of NPSLE patients. Test the peak value of NAA, Cho and Cr and calculate the NAA/Cr and Cho/Cr ratio, compared NPSLE group, the SLE group and control group in metabolites ratio.14patients with NPSLE of cMRI is abnormal and12patients of cMRI is negative, we will NPSLE group further divided into the MRI positive and negative groups based of MRI manifestation, to compare differences in MRI positive group, MRI negative groups, SLE group and control group.4heavier cases of26patients with NPSLE underwent a second magnetic resonance imaging after treatment, analyzes two checks and assess the value in the prognosis and disease progression by use cMRI combined1H-MRS.Results conventional MRI performance of NPSLE is for summarized the following three patterns:(1) simple white matter focal (5cases) or gray accompanied with white matter focal high signal (3cases), white matter and/or gray matter focal high signal can occur in any part of the cerebrum, brain stem and the cerebellum, and have no specific performance compared with SLE patients, but there are the trends of bigger size, more lesions, the more younger.(2) more diffuse white matter high signal (2patients), this change has certain specific, lesions center located mainly in the white matter, and have some involvement of deep cortex.(3) gray matter diffuse high signal (4cases), the change is a NPSLE specific, but the proportion is low, only15%;(4) cMRI negative patients(12cases).all26patients with NPSLE have different degrees of abnormal changes in NAA/Cr or Cho/Cr ratio. NAA/Cr reduce of NPSLE group has significant difference compared with control group (p=0.003), Cho/Cr elevation has significant (p=0.02). NPSLE group compared with SLE group NAA/Cr and Cho/Cr reduced and increased respectively, but have no significant (p>0.05).26NPSLE patients have cMRI positive14cases (54%) and cMRI negative12cases (46%). cMRI positive group of NAA/Cr and Cho/Cr lower (p<0.01) and increased (p<0.05) respectively, which will have a statistically significant, but NAA/Cr reduce is more obvious; cMRI negative compared with control group, Cho/Cr increase have a statistics difference (p<0.05), NAA/Cr decrease have not a statistics difference (p>0.05). four patients with diffuse gray matter high signal in14cMRI positive cases NAA peak reduced and Cho peak rose obviously, and is visible to the naked eye.4follow-up cases after treatment of patients, cMRI performance is consistent with disease progression, but NAA further reduced, Cho peak reduce (have the trend of returning to normal height), and the emerged the distinctive Lac peak.Conclusions In conventional MRI of NPSLE we observed several differenced mode, it shows that the NPSLE may be caused by a variety of pathogenic mechanism; DWI plays an important role in judging NPSLE disease activity and in the differential diagnosis; We found each metabolites abnormal changes in the normal area far from MRI lesions or in patients with negative MRI, which increased the NPSLE diagnosis sensitivity and specificity; In addition, MRI combined with1H-MRS in assessing NPSLE pathological process and prognosis also has important value.