Seminars in Arthritis and Rheumatism
Volume 40, Issue 1 , Pages 32-52, August 2010

Magnetic Resonance Imaging and Brain Histopathology in Neuropsychiatric Systemic Lupus Erythematosus

  • Wilmer L. Sibbitt Jr, MD

      Affiliations

    • Professor of Rheumatology and Neurology, The University of New Mexico Heath Sciences Center, Albuquerque, NM
    • Corresponding Author InformationAddress reprint requests to: Wilmer L. Sibbitt Jr, MD, Department of Internal Medicine, Division of Clinical Immunology and Rheumatic Diseases, MSC 10 5550, 5th FL ACC, University of New Mexico Health Sciences Center, Albuquerque, NM 87131
    • ,
  • William M. Brooks, PhD

      Affiliations

    • Director, Hoglund Brain Imaging University of Kansas Health Sciences Center, Kansas City, KS
    • ,
  • Mario Kornfeld, MD

      Affiliations

    • Professor of Neuropathology, The University of New Mexico Heath Sciences Center, Albuquerque, NM
    • ,
  • Blaine L. Hart, MD

      Affiliations

    • Professor of Radiology, The University of New Mexico, Albuquerque, NM
    • ,
  • Arthur D. Bankhurst, MD

      Affiliations

    • Professor of Rheumatology, The University of New Mexico Heath Sciences Center, Albuquerque, NM
    • ,
  • Carlos A. Roldan, MD

      Affiliations

    • Professor of Cardiology, The University of New Mexico Heath Sciences Center, Albuquerque, NM

published online 02 November 2009.

Objective

Magnetic resonance imaging (MRI) often demonstrates brain lesions in neuropsychiatric systemic lupus erythematosus (NPSLE). The present study compared postmortem histopathology with premortem MRI in NPSLE.

Methods

Two hundred subjects with NPSLE were studied prospectively with MRI over a 10-year period during which 22 subjects died. In 14 subjects, a brain autopsy with histopathology, that permitted direct comparison with premortem MRI, was successfully obtained. Surface anatomy was used to determine the approximate location of individual lesions.

Results

Premortem MRI findings in fatal NPSLE were small focal white matter lesions (100%), cortical atrophy (64%), ventricular dilation (57%), cerebral edema (50%), diffuse white matter abnormalities (43%), focal atrophy (36%), cerebral infarction (29%), acute leukoencephalopathy (25%), intracranial hemorrhage (21%), and calcifications (7%). Microscopic findings in fatal NPSLE included global ischemic changes (57%), parenchymal edema (50%), microhemorrhages (43%), glial hyperplasia (43%), diffuse neuronal/axonal loss (36%), resolved cerebral infarction (33%), microthomboemboli (29%), blood vessel remodeling (29%), acute cerebral infarction (14%), acute macrohemorrhages (14%), and resolved intracranial hemorrhages (7%). Cortical atrophy and ventricular dilation seen by MRI accurately predicted brain mass at autopsy (r = −0.72, P = 0.01, and r = −0.77, P = 0.01, respectively). Cerebral autopsy findings, including infarction, cerebral edema, intracranial hemorrhage, calcifications, cysts, and focal atrophy, were also predicted accurately by premortem MRI.

Conclusion

Brain lesions in NPSLE detected by MRI accurately represent serious underlying cerebrovascular and parenchymal brain injury on pathology.

Keywords: SLE, neuropsychiatric, magnetic resonance, NPSLE, MRI, autopsy

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 This work was supported by research grants from the US National Institutes of Health including R01 HL077422-01-A3 to Dr. Roldan, R01 NS039123 to Dr. Brooks, and R01 NS035708 to Dr. Sibbitt.

PII: S0049-0172(09)00100-0

doi:10.1016/j.semarthrit.2009.08.005

Refers to erratum:

  • Erratum to Magnetic Resonance Imaging and Brain Histopathology in Neuropsychiatric Systemic Lupus Erythematosus

    Seminars in Arthritis and Rheumatism February 2011 (Vol. 40, Issue 4, Page 369)

Seminars in Arthritis and Rheumatism
Volume 40, Issue 1 , Pages 32-52, August 2010

Article Tools

* Image Usage & Resolution