FRI0599 Evaluation of Brain Changes in Systemic Sclerosis Patients Using Two Different Techniques of MRI
Authors: R. M Gamal, A. M Ghandour, M. AA Galal, M. Zidan
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Systemic sclerosis (SSc) is a rare chronic multi-system autoimmune disease of unknown cause and a complex pathogenesis. The hallmark of the disease is microvscular vasculopathy which results in tissue ischemia with recurrent episodes of reperfusion. Diffusion-weighted (DW) Magnetic Resonance imaging (MRI) is an excellent tool for the detection of activity of any vascular or inflammatory lesions. <h3>Objectives</h3> Detect brain changes in systemic sclerosis patients with asymptomatic CNS manifestations using fluid attenuation inversion recovery (FLAIR) weighted sequence and diffusion-weighted (DW) sequence MRI. <h3>Methods</h3> Fourteen systemic sclerosis female patients (diagnosed according to the 2013 revised ACR/EULAR classification criteria for systemic sclerosis) aged 28-57 years old with disease duration of 1-20 years with no CNS clinical manifestations were included. A controlled group of 14 clinically normal persons, age and sex matched. Both groups were subjected to brain MR examination at 1.5 T; a FLAIR weighted sequence and a DW sequence. Statistical Package for the Social Sciences (SPSS, version 21) was used for statistical analysis. <h3>Results</h3> 25 white matter hyperintense lesions ≥5mm in diameter and 12 lesions &lt;5 mm were detected in patient group using FLAIR weighted MRI while diffusion weighted MRI failed to detect the same lesions. A significant correlation (p=0.018) between the presence of white matter hyperintense lesions and the severity of peripheral vascular affection of the disease was observed. <h3>Conclusions</h3> Asymptomatic central nervous system vasculopathy is detected in systemic sclerosis using FLAIR MRI, while diffusion MRI failed to detect such lesions. These findings may suggest a non-inflammatory form of central nervous system microvasculopathy in SSc patients. <h3>References</h3> Matucci-Cerinic M, Kahaleh B and Wigley FM. Evidence That Systemic Sclerosis Is a Vascular Disease. Arthritis &amp; Rheumatism 2013; 65(8):1953–1962. Mohammed RHA, Sabry YY, Nasef AA. Brain MRI screening showing evidences of early central nervous system involvement in patients with systemic sclerosis. Rheumatol Int 2011; 31: 667–671. Cutolo M, Nobili F, Sulli A et al. Evidence of cerebral hypoperfusion in scleroderma patients. Rheumatology 2000; 39:1366–1373. Sardanelli F, Lozzelli A, Cotticelli B et al.White matter hyperintensities on brain magnetic resonance in systemic sclerosis. Ann Rheum Dis 2005; 64:777–779. Mohamed RHA and Nassef AA. Brain magnetic resonance imaging findings in patients with systemic sclerosis. International Journal of Rheumatic Diseases 2010; 13: 61–67. van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65(11):2737-2747. van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis. 2013;72(11):1747-1755. <h3>Disclosure of Interest</h3> None declared