Key points are not available for this paper at this time.
Objective In this study, we examined the role of conventional brain magnetic resonance imaging (bMRI) in the evaluation of patients with neuropsychiatric systemic lupus erythematosus (NPSLE). We evaluated: 1) the diagnostic role of lesions detected on conventional bMRI at the time of the first NP event in NP manifestations attributed to SLE according by clinical judgment (CJ) and attribution algorithm (AA); 2) the treatment adopted and the 12-month outcome of the manifestations. Methods Our retrospective analysis involved a multicentric cohort of SLE patients treated between 1999 and 2018 in Brazil, Cagliari (Italy), Greece, and Ferrara (Italy). Patients were evaluated according to ACR criteria during their first NPSLE event and underwent bMRI at that time. NP manifestations were attributed to SLE using both CJ and AA. A 1.5 Tesla MRI was utilized, and detected lesions were classified into various types. Data included demographic and clinical variables, NP event classification, and treatment choices. The 12-month outcomes were assessed using the 7-point Likert scale (improvement if score >4), and statistical analysis was performed using χ2 tests and Fisher's test. Results Out of 154 patients, 88 had NP events attributed to the underlying pathology according to CJ, and 85 according to AA. Notably, 54 cases had normal bMRI results. Hyperintense lesions were the most prevalent (71/130). A higher incidence of cerebral atrophy was observed in patients with NP events not attributed according to CJ, while inflammatory lesions and myelopathy were more frequent in those attributed according to AA (table 1). Treatment choices were aligned with lesion types, with immunosuppressive drugs frequently used for inflammatory lesions and myelopathy, and antiplatelet/anticoagulant drugs for patients with parenchymal infarcts. After 12 months, myelopathy and parenchymal infarcts demonstrated more favorable clinical evolution, as indicated by the Likert scale. (figure 1) Conclusions In our study, the finding of cerebral atrophy was negatively associated with attribution according to CJ, while inflammatory lesions and myelopathy were positively associated with attribution according to AA. bMRI plays a crucial role in supporting attribution in NPSLE patients with NPSLE involvement.
Marangoni et al. (Fri,) studied this question.