The Diagnosis Of Cerebral Microbleeds Of Neuropsychiatric Systemic Lupuserythematosus By Magnetic Susceptibility Imaging ESWAN Sequence:a Preliminary Study

Objective Using magnetic susceptibility imaging ESWAN sequence to image and characterize CMBs of NPSLE patients and compared with clinical data for correlation analysis.To provide certain theoretical basis and pathogenesis for the detection of CMBs on NPSLE patients.Methods Patients diagnosed with NPSLE and hospitalized were enrolled in this study.The conventional head MRI scanning and ESWAN sequences were underwent,and the CMBs imaging features was analyzed.The baseline data（gender,age,course of history,history of hypertension,cerebral infarction）were analyzed,course with SLE was divided into 3 level;ESWAN data were analyzed by experienced neural radiologists independently,the number CMBs was divided into 3 levels,parenchymal was divided into cortex-subcortical areas,basal ganglia-thalamus area,under the curtain area（including the brain stem,cerebellum）three areas according to the CMBs distribution.Using Kappa test to assess the consistency of the observer’s classification on CMBs;chi-square test to evaluate whether there was statistical difference between CMBs and NPSLE patients with hypertension or cerebral infarction.Wilcoxon rank and test were used to analyze the age and pathogenesis of CMBs between positive and negative group.Spearman rank correlation coefficient was used to analyze the correlation between CMBs classification and NPSLE course grading.Results In this study,34 patients were diagnosed with NPSLE,32 women and 2males,including 15 cases for CMBs,the incidence was 44.12%.The CMBs was shown as a circular low signal in the ESWAN sequence,and the boundary was clear,with a diameter of about 2-5mm,and there was no obvious edema around it,while the same level of DWI T₂WI T₁-FLAIR sequence image showed no abnormal signal in the CMBs region.Age12-69,median age（40.32+15.12）,median 39.50 years,CMBs incidence and age had no statistical difference（P=0.14）;SLE course was 1 month-30 years,average（4.73-6.15）years,median 1.50 years,there was no statistical difference between CMBs morbidity and SLE course（P=0.69）.There were 9 cases of hypertension and 25 patients with no hypertension,the difference in prevalence of CMBs was statistically significant in the case of non-hypertensive and hypertensive NPSLE patients withχ²=3.921,P=0.048.There were12 patients with cerebral infarction and 22 patients without cerebral infarction,χ²=0.022,P=0.882,indicating that CMBs prevalence was not statistically significant in the case of non-cerebral infarction and cerebral infarction NPSLE patients.A total of 85 lesions in 15patients with CMBs,which 39 cases were distributed in the cortex-subcortical areas,14cases were basal ganglia-thalamus area,32 cases were under the curtain area.The morbidity of CMBs with different regions was statistically significant（χ²=10.18,P=0.01）,the incidence of which cortex-subcortical areas was the highest,basal ganglia-thalamus area and area under the prevalence had no statistical difference between groups（χ²=0.14,P=0.50）.The Kappa value was 0.795,CI 0.533-1.000.There was no statistically significant correlation between CMBs number classification and SLE course classification（P=0.98）.Conclusion CMBs had a high morbidity in NPSLE patients,and the CMBs distribution of patients with NPSLE was mainly in the cortex-subcortical areas,which was not consistent with patients with hypertension.There was no correlation with baseline data of cerebral infarction,SLE course and age.CMBs lesions have certain image characteristics in ESWAN sequences.The ESWAN sequence is a very sensitive and accurate imaging technique for the diagnosis of CMBs,and the repeatability is better.However,the relevant pathologic mechanisms need to be further studied.