THU0351 Susceptibility to cerebral ischemia in early lupus patients: a pilot study of co-registration with conventional brain mri, diffusion- and perfusion-weighted imaging
Authors: E. Silvagni, A. Revenaz, A. Bortoluzzi, E. Groppo, M. Padovan, M. Borrelli, S. Ceruti, C.A. Scirè, E. Fainardi, M. Govoni
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Conventional brain Magnetic Resonance Imaging (cMRI) has a limited usefulness in patients with early diagnosis of Systemic Lupus Erythematosus (SLE), showing not specific abnormalities in up to half of the patients. No data are available about cMRI combined with advanced MRI techniques in early SLE patients. <h3>Objectives</h3> To evaluate differences between early SLE patients, even without overt neuropsychiatric (NP) manifestations, and healthy controls (HCs) in a monocentric cohort, using data derived from cMRI, diffusion-weighted imaging (DWI) and perfusion-imaging (PWI). <h3>Methods</h3> Patients referred to a single tertiary rheumatologic centre with early diagnosis of SLE (less than 24 months), aged less than 55, were consecutively enrolled (01/05/2013–31/12/2017) and imaged with cMRI, DWI and PWI (1.5 Tesla Philips "Signa Achieva" scanner). Data were analysed with a semi-automated measuring system (Diffusion/Perfusion Project Suite, developed in Multiple Sclerosis patients) to co-registrate apparent diffusion coefficient (ADC), cerebral blood flow (CBF) and volume (CBV), mean transit time (MTT) in normal appearing grey (NAGM) and white matter (NAWM), deep GM (putamen, pallidus, caudate, thalamus) and lesions. Demographic, clinical, serological and treatment information were collected as well as NP events at baseline attributed to SLE according to a validated algorithm. Statistical analysis were performed by comparing median (interquartile range, IQR) values for skewed variables between SLE and HCs and with quantile regression adjusted for cardiovascular comorbidities (hypertension, diabetes, previous coronary heart disease, hyperlipidaemia, obesity). <h3>Results</h3> 30 patients with early SLE (mean age 37.0 years, standard deviation SD 10.7, 27 females) and 8 HCs (mean age 40.6, SD 11.2, 6 females) were enrolled. MRI was performed after a mean period of 259 days from diagnosis; mean (SD) Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2k) was 8.87 (3.85) while mean (SD) Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was 0.40 (0.72); 3 patients were classified as NPSLE at diagnosis. Median (IQR) values of ADC in NAGM and NAWM were 1.15 × 10–3 mm2/s (1.12–1.16) and 0.86 (0.85–0.88) in SLE, 1.28 (1.16–1.33) and 0.97 (0.87–0.98) in HCs respectively (table 1). After adjusting for comorbidities, median differences between ADC values remained significant (p&lt;0.001). SLE patients had lower median ADC values at bilateral putamen and pallidus. No differences were found in perfusion parameters in all the regions of interest (ROI) and lesions. A trend towards lower CBV and CBF and higher MTT values for NAGM-NAWM in NPSLE compared to non-NPSLE was found. <h3>Conclusions</h3> Lower ADC values in normal appearing GM and WM in early SLE patients could reflect susceptibility to cerebral ischemia, partially confirmed analysing perfusional data in NPSLE patients. Further prospective studies with higher sample size are necessary to confirm these findings. <h3>References</h3> [1] Petri, et al. J Rheum2008. [2] Bortoluzzi, et al. Rheumatology (Oxford)2015. [3] Revenaz, et al. BMC Med Imaging2016. [4] Papadaki, et al. Ann Rheum Dis2017. <h3>Disclosure of Interest</h3> None declared