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Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 1009-1013. doi: 10.19723/j.issn.1671-167X.2018.06.012

• Article • Previous Articles     Next Articles

Multidisciplinary classification of magnetic resonance imaging features of neuropsychiatric lupus

Jun-ying CHANG1,Mei ZHENG2,Ying LIU3,Rui LIU4,Jing-feng ZHANG4,Xiao-li DENG4,△()   

  1. 1. Department of Rheumatology and Immunology,Handan Hospital of Traditional Chinese Medicine, Handan 056001, Hebei, China
    2. Department of Neurology
    3. Department of Radiology
    4. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2018-07-27 Online:2018-12-18 Published:2018-12-18
  • Contact: Xiao-li DENG E-mail:1930473013@qq.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81501390)

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Abstract:

Objective: To investigate the clinical correlation between the manifestations of neuropsychiatric lupus (NPSLE) and brain magnetic resonance imaging (MRI).Methods:Retrospective analysis of 65 neuropsychiatric lupus patients with brain MRI and clinical data from Peking University Third Hospital from January 2006 to October 2016, which was classified by rheumatologist, neurologists, and radiologists based on their brain MRI findings. The correlation between brain MRI findings and clinical manifestations was analyzed.Results:The characteristics of the brain MRI of the 65 patients were divided into 6 categories: 16 cases (25%) with demyelination in the white matter, 15 cases (23%) with cerebrovascular disease, including 4 cases (6%) with large vascular disease and 11 cases (17%) with small vessel disease, 4 cases (6%) with inflammation, 4 cases (6%) with edema, 13 cases (20%) with multiple manifestation coexistence, and 13 cases (20%) without any abnormality. Except for 4 cases of brain MRI with edema, the clinical manifestations were only epileptic seizures, other patients had complex and diverse clinical manifestations, including epileptic seizures, lupus-like headaches, mental symptoms, blurred vision, peripheral neuropathy and disturbance of consciousness. The incidence of epileptic seizures in patients with edema of MRI is significantly higher than that of other patients, and the therapeutic response time is the shortest.Conclusion:Multidisciplinary collaboration divides the MRI findings of neuropsychiatric lupus patients into six categories. This classification method helps clinicians to predict and intervene early possible neuropsychiatric symptoms to guide clinical treatment.

Key words: Lupus vasculitis,central nervous system, Magnetic resonance imaging, Clinical symptoms

CLC Number: 

  • R593.24

Table 1

Correspondence between brain MRI and clinical manifestations and treatment outcomes"

MRI results MRI manifestation Clinical manifestation Treatment Treatment response time, median (quartile) Prognosis
Edema (n=4) PRES Epilepsy (1)Intrathecal DXM+
MTX; (2) MP+MMF+
Carbamazepine+Pheno-
barbital		 3.50 (3.00, 11.50) No recurrence
Demyelination
(n=16)		 Multiple point-like demyelination Psychiatric symptoms,
convulsions, headache,
peripheral neuropathy,
disturbance of consciousness, lethargy with blurred vision, headache with
speech disorder, headache with blurred vision		 (1)Intrathecal DXM+
MTX; (2) MMF		 19.00 (15.00, 26.50)* Recurrence in 1 cases
Vascular lesion
(n=15)		 (1)Multiple vascular infarction; (2) watershed
cerebral infarction; (3) middle cerebral artery
blood supply area embolization; (4) old lacunar
infarctions; (5) thalamic
infarction		 Headache, left limb weakness, slurred speech, psychiatric symptoms, peri-
pheral neuropathy, head-
ache with blurred vision, right limb weakness,
epilepsy		 (1)Intrathecal DXM+
MTX; (2) MP+CTX+MMF+HCQ+Anticoagulation+Carbamazepine		 15.00 (14.00, 20.00)* Recurrence in 2 cases
Inflammation
(n=4)		 Inflammation Unclear speech with weak limbs epilepsy, lethargy,
blurred vision		 MP+MMF+HCQ 15.00 (12.00, 19.50) No recurrence
Multiple coexistence (n=13) (1)Demyelination+lacunar infarctions; (2)lacunar infarctions+edema;
(3)PRES+a small
amount of inflammatory
signal		 Numbness of both lower
extremities, headache, vision loss, convulsions,
mental symptoms, head-
ache with convulsions, difficulty in articulation, convulsions and decreased
muscle strength in both
lower extremities		 (1)Intrathecal DXM+MTX; (2) MP+CTX+MMF+CsA+AZA+Anticoagulation+Sodium valproate+Olanzapine 15.00 (13.50, 17.50) Recurrence in 3 cases
No abnormality
(n=13)		 No abnormality Epilepsy, speech disorder, headache, mental symp-
toms, convulsions with
psychiatric symptoms,
mental symptoms with
numbness of both lower extremities, mental disorders with confusion		 (1)Intrathecal DXM+MTX; (2) MP+MMF+HCQ+Olanzapine+Carbamazepine+Mesenchymal stem cells transfusion 13.00 (9.00, 14.50)# No recurrence

Figure 1

Comparison of the incidence of epileptic seizures between the brain MRI edema group and other groups *P<0.01, vs. edema."

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