Quantitative Magnetic Resonance Imaging Analyses and Clinical Significance of Hyperintense White Matter Lesions in Systemic Lupus Erythematosus Patients

Autor(es)

Appenzeller, Simone ^{[1, 2]} ; Faria, Andrea Vasconcelos ^[3] ; Li, Li Min ^{[2, 4]} ; Costallat, Lilian T. L. ^[1] ; Cendes, Fernando ^{[2, 4]}

Afiliação do(s) autor(es)

^[1] State Univ Campins, Dept Rheumatol, Sao Paulo - Brazil

^[2] State Univ Campins, Neuroimaging Lab, Sao Paulo - Brazil

^[3] State Univ Campins, Dept Radiol, Sao Paulo - Brazil

^[4] State Univ Campins, Dept Neurol, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: ANNALS OF NEUROLOGY; v. 64, n. 6, p. 635-643, DEC 2008.
• Citações Web of Science: 70

Resumo

Objective: To analyze the clinical significance of hyperintense white matter (WM) lesions in both symptomatic and asymptomatic systemic lupus erythematosus (SLE) patients. Methods: We studied 120 consecutive SLE patients and 44 healthy volunteers. Fluid attenuated inversion recovery and T2-weighted magnetic resonance images (MRI) were used for visual and semiautomatic volumetric measurements. Results: At baseline, 61 MRI were normal and 59 had hyperintense WM lesions. Mean volumes of WM lesions were 96.14 (SD = 85.14) mm(3) in T2 weighted and 197.2 (161.13) mm(3) in FLAIR images. The Volume of WM lesions was associated with age (r = 0.45; p = 0.01), total corticosteroid dose (r = 0.53; p = 0.001), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores (r = 0.55; p = 0.002). After a median follow-up time of 24 months (SD = 2.3; range = 12-28 months), 20 patients had still normal MRIs, 30 patients had stable MRI findings, and 30 had new WM lesions. Predictors for new or increased WM lesions were past central nervous system manifestations (p = 0.001; OR = 12.2; 95% CI = 3.5-21.2), antiphospholipid antibodies (p = 0.003; OR = 6.9; 95% CI = 2.1-15.3); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores (p = 0.002; OR = 7.2; 95% CI = 1.4-17.8) and higher dose of total corticosteroid dose (p = 0.01; OR = 2.4; 95% CI = 1.4-6.7). Conclusion: Small hyperintense WM lesions in SLE are associated with central nervous system symptoms and antiphospholipid antibodies, and progress over time in patients with more severe SLE. Therefore, in the on context of SLE, these lesions arc likely consequences of central nervous system damage and not mere incidental finding. (AU)

• Processo FAPESP: 03/01527-0 - Análise quantitativa e qualitativa de lesões na substância branca através da ressonância magnética no lúpus eritematoso sistêmico
• Beneficiário: Simone Appenzeller
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto
• Processo FAPESP: 06/50260-5 - Avaliação estrutural e funcional do sistema nervoso central através da ressonância magnética no lúpus eritematoso sistêmico
• Beneficiário: Simone Appenzeller
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado