Imaging of Neuropsychiatric Systemic Lupus Erythematosus

  • Yoshiyuki Arinuma
  • Shunsei Hirohata
Chapter

Abstract

The diagnosis of neuropsychiatric manifestations in systemic lupus erythematosus (NPSLE) is challenging. Neuroimaging is very important technique for the evaluation of abnormalities occurred in the central nervous system (CNS). Computed tomography (CT) scan is one of the common techniques and is very useful to detect a large lesion such as ischemic stroke, hemorrhage and tumor, providing help to rule out CNS diseases other than SLE. Magnetic resonance imaging (MRI) is the best tool at present to detect parenchymal lesions in the CNS. Conventional MRI figures out exact abnormalities in the CNS causing neurologic or psychiatric symptoms. However, it should be remembered that MRI abnormalities in patients with NPSLE are not always specific for NPSLE. New MRI techniques can give us more detailed information in patients with NPSLE in addition to findings by conventional MRI. Functional analysis of the CNS by imaging system would be promising.

Keywords

NPSLE Neuroimaging Central nervous system MRI 

References

  1. 1.
    Ainiala H, et al. Validity of the new American College of Rheumatology criteria for neuropsychiatric lupus syndromes: a population-based evaluation. Arthritis Rheum. 2001;45:419–23.CrossRefPubMedGoogle Scholar
  2. 2.
    Bertsias GK, et al. EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis. 2010;69:2074–82.CrossRefPubMedGoogle Scholar
  3. 3.
    Chang Y-S, et al. Increased risk of subarachnoid hemorrhage in patients with systemic lupus erythematosus: a nationwide population-based study. Arthritis Care Res (Hoboken). 2013;65:601–6.CrossRefGoogle Scholar
  4. 4.
    Mimori A, et al. Subarachnoid hemorrhage and systemic lupus erythematosus. Lupus. 2000;9:521–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Liang MH, et al. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42:599–608.CrossRefGoogle Scholar
  6. 6.
    Raymond AA, et al. Brain calcification in patients with cerebral lupus. Lupus. 1996;5:123–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Nordstrom DM, West SG, Andersen PA. Basal ganglia calcifications in central nervous system lupus erythematosus. Arthritis Rheum. 1985;28:1412–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Anderson JR. Intracerebral calcification in a case of systemic lupus erythematosus with neurological manifestations. Neuropathol Appl Neurobiol. 1981;7:161–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Sibbitt WL, et al. Magnetic resonance imaging and brain histopathology in neuropsychiatric systemic lupus erythematosus. Semin Arthritis Rheum. 2010;40:32–52.CrossRefPubMedGoogle Scholar
  10. 10.
    Luyendijk J, et al. Neuropsychiatric systemic lupus erythematosus: lessons learned from magnetic resonance imaging. Arthritis Rheum. 2011;63:722–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Steup-Beekman GM, et al. Neuropsychiatric manifestations in patients with systemic lupus erythematosus: epidemiology and radiology pointing to an immune-mediated cause. Ann Rheum Dis. 2013;72(Suppl 2):ii76–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Karassa FB, et al. Predictors of clinical outcome and radiologic progression in patients with neuropsychiatric manifestations of systemic lupus erythematosus. Am J Med. 2000;109:628–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Sanna G, et al. Central nervous system involvement in systemic lupus erythematosus: cerebral imaging and serological profile in patients with and without overt neuropsychiatric manifestations. Lupus. 2000;9:573–83.CrossRefPubMedGoogle Scholar
  14. 14.
    Appenzeller S, et al. Quantitative magnetic resonance imaging analyses and clinical significance of hyperintense white matter lesions in systemic lupus erythematosus patients. Ann Neurol. 2008;64:635–43.CrossRefPubMedGoogle Scholar
  15. 15.
    McCune WJ, et al. Identification of brain lesions in neuropsychiatric systemic lupus erythematosus by magnetic resonance scanning. Arthritis Rheum. 1988;31:159–66.CrossRefPubMedGoogle Scholar
  16. 16.
    Sibbitt WL, et al. Neuroimaging in neuropsychiatric systemic lupus erythematosus. Arthritis Rheum. 1999;42:2026–38.CrossRefPubMedGoogle Scholar
  17. 17.
    Harris EN, et al. Cerebral disease in systemic lupus erythematosus. Springer Semin Immunopathol. 1985;8:251–66.CrossRefPubMedGoogle Scholar
  18. 18.
    Arinuma Y, et al. Brain MRI in patients with diffuse psychiatric/neuropsychological syndromes in systemic lupus erythematosus. Lupus Sci Med. 2014;1:e000050.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Castellino G, et al. Single photon emission computed tomography and magnetic resonance imaging evaluation in SLE patients with and without neuropsychiatric involvement. Rheumatology (Oxford). 2008;47:319–23.CrossRefGoogle Scholar
  20. 20.
    Walecki J, et al. MR in neurological syndromes of connective tissue diseases. Med Sci Monit. 2002;8:MT105–11.PubMedGoogle Scholar
  21. 21.
    Moritani T, et al. Diffusion-weighted echo-planar MR imaging of CNS involvement in systemic lupus erythematosus. Acad Radiol. 2001;8:741–53.CrossRefPubMedGoogle Scholar
  22. 22.
    Bosma GPT, et al. Abnormal brain diffusivity in patients with neuropsychiatric systemic lupus erythematosus. AJNR Am J Neuroradiol. 2003;24:850–4.PubMedGoogle Scholar
  23. 23.
    Hjort N, et al. Ischemic injury detected by diffusion imaging 11 minutes after stroke. Ann Neurol. 2005;58:462–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Roldan CA, et al. Libman-sacks endocarditis and embolic cerebrovascular disease. JACC Cardiovasc Imaging. 2013;6:973–83.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Ellison D, et al. Intramural platelet deposition in cerebral vasculopathy of systemic lupus erythematosus. J Clin Pathol. 1993;46:37–40.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Brooks WM, et al. The histopathologic associates of neurometabolite abnormalities in fatal neuropsychiatric systemic lupus erythematosus. Arthritis Rheum. 2010;62:2055–63.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Arinuma Y, et al. Histopathological analysis of cerebral hemorrhage in systemic lupus erythematosus complicated with antiphospholipid syndrome. Mod Rheumatol. 2011;21:509–13.CrossRefPubMedGoogle Scholar
  28. 28.
    Tono T, et al. Transverse myelitis extended to disseminated encephalitis in systemic lupus erythematosus: histological evidence for vasculitis. Mod Rheumatol. 2016;26:958–62.PubMedGoogle Scholar
  29. 29.
    De Boysson H, et al. Primary angiitis of the central nervous system: description of the first fifty-two adults enrolled in the french cohort of patients with primary vasculitis of the central nervous system. Arthritis Rheumatol. 2014;66:1315–26.CrossRefPubMedGoogle Scholar
  30. 30.
    Boerma C, et al. An acute multiorgan thrombotic disorder associated with antiphospholipid antibodies; two “catastrophic” cases. Ann Rheum Dis. 1997;56(9):568.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Boura P, et al. Intracerebral hemorrhage in a patient with SLE and catastrophic antiphospholipid syndrome (CAPS): report of a case. Clin Rheumatol. 2005;24(4):420.CrossRefPubMedGoogle Scholar
  32. 32.
    Magro Checa C, et al. Demyelinating disease in SLE: is it multiple sclerosis or lupus? Best Pract Res Clin Rheumatol. 2013;27:405–24.CrossRefPubMedGoogle Scholar
  33. 33.
    Wingerchuk DM, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85:177–89.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Mader S, et al. Understanding the antibody repertoire in neuropsychiatric systemic lupus erythematosus and neuromyelitis optica spectrum disorders: do they share common targets? Arthritis Rheumatol (Hoboken, NJ). 2017. doi: https://doi.org/10.1002/art.40356.
  35. 35.
    Merayo-Chalico J, et al. Clinical outcomes and risk factors for posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a multicentric case-control study. J Neurol Neurosurg Psychiatry. 2016;87:287–94.CrossRefPubMedGoogle Scholar
  36. 36.
    Hugonnet E, et al. Posterior reversible encephalopathy syndrome (PRES): features on CT and MR imaging. Diagn Interv Imaging. 2013;94:45–52.CrossRefPubMedGoogle Scholar
  37. 37.
    Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol. 2012;11:906–17.CrossRefPubMedGoogle Scholar
  38. 38.
    Dasgupta N, et al. Central nervous system lymphoma associated with mycophenolate mofetil in lupus nephritis. Lupus. 2005;14:910–3.CrossRefPubMedGoogle Scholar
  39. 39.
    Tsang HHL, et al. Diffuse large B-cell lymphoma of the central nervous system in mycophenolate mofetil-treated patients with systemic lupus erythematosus. Lupus. 2010;19(3):330.CrossRefPubMedGoogle Scholar
  40. 40.
    Svobodova B, et al. Brain diffuse large B-cell lymphoma in a systemic lupus erythematosus patient treated with immunosuppressive agents including mycophenolate mofetil. Lupus. 2011;20:1452–4.CrossRefPubMedGoogle Scholar
  41. 41.
    Sibbitt WL, et al. Fluid Attenuated Inversion Recovery (FLAIR) imaging in neuropsychiatric systemic lupus erythematosus. J Rheumatol. 2003;30:1983–9.PubMedGoogle Scholar
  42. 42.
    Raina A, et al. Cerebral white matter hyperintensities on MRI and acceleration of epigenetic aging: the atherosclerosis risk in communities study. Clin Epigenetics. 2017;9:21.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Jeong HW, et al. Brain MRI in neuropsychiatric lupus: associations with the 1999 ACR case definitions. Rheumatol Int. 2015;35:861–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Appenzeller S, et al. Cerebral and corpus callosum atrophy in systemic lupus erythematosus. Arthritis Rheum. 2005;52(9):2783.CrossRefPubMedGoogle Scholar
  45. 45.
    Kozora E, et al. Magnetic resonance imaging abnormalities and cognitive deficits in systemic lupus erythematosus patients without overt central nervous system disease. Arthritis Rheum. 1998;41:41–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Appenzeller S, et al. Longitudinal analysis of gray and white matter loss in patients with systemic lupus erythematosus. NeuroImage. 2007;34:694–701.CrossRefPubMedGoogle Scholar
  47. 47.
    Ainiala H, et al. Cerebral MRI abnormalities and their association with neuropsychiatric manifestations in SLE: a population-based study. Scand J Rheumatol. 2005;34:376–82.CrossRefPubMedGoogle Scholar
  48. 48.
    Coan AC, et al. Quantification of hippocampal signal intensity in patients with mesial temporal lobe epilepsy. J Neuroimaging. 2003;13:228–33.CrossRefPubMedGoogle Scholar
  49. 49.
    Appenzeller S, et al. Hippocampal atrophy in systemic lupus erythematosus. Ann Rheum Dis. 2006;65:1585–9.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Lapa AT, et al. Abnormality in hippocampal signal intensity predicts atrophy in patients with systemic lupus erythematosus. Lupus. 2017;26:633–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Sanchez-Garcia M, et al. Hypertrophic pachymeningitis associated with cerebral spinal fluid hypovolemia as initial presentation of systemic lupus erythematous. Lupus. 2014;23:197–200.CrossRefPubMedGoogle Scholar
  52. 52.
    Han F, et al. Cranial and lumbosacral hypertrophic pachymeningitis associated with systemic lupus erythematosus: a case report. Medicine (Baltimore). 2016;95:e4737.CrossRefGoogle Scholar
  53. 53.
    Guillen-Del Castillo A, et al. Increased myo-inositol in parietal white and gray matter as a biomarker of poor prognosis in neuropsychiatric lupus: a case report. Lupus. 2014;23:1073–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Huizinga TW, et al. Imaging modalities in central nervous system systemic lupus erythematosus. Curr Opin Rheumatol. 2001;13:383–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Sibbitt WL, et al. Neuropsychiatric systemic lupus erythematosus. Compr Ther. 1999;25:198–208.CrossRefPubMedGoogle Scholar
  56. 56.
    Brooks WM, et al. Relationship between neurometabolite derangement and neurocognitive dysfunction in systemic lupus erythematosus. J Rheumatol. 1999;26:81–5.PubMedGoogle Scholar
  57. 57.
    Alexander AL, et al. Characterization of cerebral white matter properties using quantitative magnetic resonance imaging stains. Brain Connect. 2011;1:423–46.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Costallat BL, et al. Brain diffusion tensor MRI in systematic lupus erythematosus: a systematic review. Autoimmun Rev. 2018;17:36–43.CrossRefPubMedGoogle Scholar
  59. 59.
    Bosma GP, et al. Evidence of central nervous system damage in patients with neuropsychiatric systemic lupus erythematosus, demonstrated by magnetization transfer imaging. Arthritis Rheum. 2000;43:48–54.CrossRefPubMedGoogle Scholar
  60. 60.
    Bosma GP, et al. Detection of cerebral involvement in patients with active neuropsychiatric systemic lupus erythematosus by the use of volumetric magnetization transfer imaging. Arthritis Rheum. 2000;43:2428–36.CrossRefPubMedGoogle Scholar
  61. 61.
    Emmer BJ, et al. Correlation of magnetization transfer ratio histogram parameters with neuropsychiatric systemic lupus erythematosus criteria and proton magnetic resonance spectroscopy: association of magnetization transfer ratio peak height with neuronal and cognitive dy. Arthritis Rheum. 2008;58:1451–7.CrossRefPubMedGoogle Scholar
  62. 62.
    Magro-Checa C, et al. Changes in white matter microstructure suggest an inflammatory origin of neuropsychiatric systemic lupus erythematosus. Arthritis Rheumatol (Hoboken, NJ). 2016;68:1945–54.CrossRefGoogle Scholar
  63. 63.
    Saito T, et al. Regional cerebral glucose metabolism in systemic lupus erythematosus patients with major depressive disorder. J Neurol Sci. 2017;379:127–30.CrossRefPubMedGoogle Scholar
  64. 64.
    Mackay M, et al. Brain metabolism and autoantibody titres predict functional impairment in systemic lupus erythematosus. Lupus Sci Med. 2015;2:e000074.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Yoshiyuki Arinuma
    • 1
  • Shunsei Hirohata
    • 2
    • 3
  1. 1.Department of Rheumatology and Infectious diseasesKitasato University School of MedicineSagamiharaJapan
  2. 2.Department of RheumatologyNobuhara HospitalTatsunoJapan
  3. 3.Department of Rheumatology & Infectious DiseasesKitasato University School of MedicineSagamiharaJapan

Personalised recommendations