RT Journal Article
SR Electronic
T1 Alterations in Blood-Brain Barrier Permeability in Patients with Systemic Lupus Erythematosus
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 470
OP 477
DO 10.3174/ajnr.A5990
VO 40
IS 3
A1 J.M. Chi
A1 M. Mackay
A1 A. Hoang
A1 K. Cheng
A1 C. Aranow
A1 J. Ivanidze
A1 B. Volpe
A1 B. Diamond
A1 P.C. Sanelli
YR 2019
UL http://www.ajnr.org/content/40/3/470.abstract
AB BACKGROUND AND PURPOSE: Neuropsychiatric systemic lupus erythematosus refers to central and peripheral nervous system involvement, which may occur secondary to antineuronal antibodies crossing the blood-brain barrier that preferentially target cells in the hippocampus leading to abnormal hypermetabolism and atrophy. Thus, we hypothesized that alterations in BBB permeability, detected on dynamic contrast-enhanced MR imaging, occur in the hippocampus in patients with systemic lupus erythematosus before development of neuropsychiatric systemic lupus erythematosus.MATERIALS AND METHODS: Six patients with systemic lupus erythematosus without neuropsychiatric systemic lupus erythematosus and 5 healthy controls underwent dynamic contrast-enhanced MR imaging with postprocessing into BBB permeability parameters (Ktrans and Ve) and CBF. Standardized methods selected ROI sampling of the abnormal brain regions detected on FDG-PET. The mean and SD of Ktrans, Ve, and CBF were calculated. Linear regression and nonparametric Spearman rank correlation analyses of Ktrans and Ve with CBF were performed. Dynamic contrast-enhanced curves and the area under the curve were generated for each brain region. Student t test comparisons were performed.RESULTS: Quantitative data revealed that patients with systemic lupus erythematosus have statistically increased Ktrans (P < .001) and Ve (P < .001) compared with controls. In patients with systemic lupus erythematosus, statistically significant positive correlations were seen between Ktrans (P < .001) and Ve (P < .001) with CBF. Furthermore, the mean area under the curve revealed statistically increased BBB permeability in the hippocampus (P = .02) compared with other brain regions in patients with systemic lupus erythematosus compared with controls.CONCLUSIONS: These initial findings are proof-of-concept to support the hypothesis that patients with systemic lupus erythematosus have increased BBB permeability, specifically in the hippocampus, compared with other brain regions. These findings may advance our understanding of the underlying pathophysiology affecting the brain in autoimmune diseases.ANAMAutomated Neuropsychological Assessment MetricBBBPBBB permeabilityDCEdynamic contrast-enhancedDNRAbN-methyl-D-aspartate receptor antibodiesKtransvolume transfer constantNMDARN-methyl-D-aspartate receptorNPSLEneuropsychiatric systemic lupus erythematosusSLEsystemic lupus erythematosusVevolume in the extravascular extracellular space per unit of tissue volume