POS1118 ROLE OF CONVENTIONAL MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF PATIENTS WITH NEUROPSYCHIATRIC INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Authors: A. Marangoni, C. Garaffoni, E. Silvagni, S. Appenzeller, G. K. Bertsias, A. Fanouriakis, M. Piga, M. Govoni, A. Bortoluzzi
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) is challenging and its diagnosis requires a comprehensive, multidisciplinary approach to rule out mimicking conditions. Although conventional magnetic resonance imaging (MRI) of the brain does not show specific changes and may even be negative in 40% of NPSLE cases, it is still considered the reference method for evaluating patients with NP complications. <h3>Objectives:</h3> To examine the role of conventional brain MRI (bMRI) in evaluating patients with NPSLE. We assessed the diagnostic role of lesions detected on conventional bMRI at the time of the first NP event, in manifestations attributed to SLE by both clinical judgment (CJ) and an attribution algorithm (AA) (1). Additionally, we investigated administered treatments and the 12-month outcome of these manifestations. <h3>Methods:</h3> Multicenter retrospective cohort study of SLE patients followed between 1999 and 2018 in Brazil, Cagliari (Italy), Greece, and Ferrara (Italy). Patients were evaluated according to ACR criteria and underwent bMRI during their first NPSLE event. NP manifestations were attributed to SLE using both CJ and AA. Detected lesions in bMRI were classified into the following types: large infarcts, parenchymal hemorrhages, subarachnoid hemorrhages, inflammatory lesions, myelopathy, hyperintense lesions, sequelae, cerebral atrophy. Outcome of NPSLE at 12 months was assessed using a 7-point Likert scale (improvement if score &gt;4). Statistical analysis was performed using χ2 tests and Fisher's test. <h3>Results:</h3> Of 154 patients, 88 had NP events attributed to the underlying pathology according to CJ, and 85 according to AA. The characteristics of included patients are presented in Table 1. Notably, 54 cases had normal bMRI results. Hyperintense lesions in T2/FLAIR were the most prevalent (71/130) finding. A higher incidence of cerebral atrophy was observed in patients with NP events not attributed to SLE according to CJ, while inflammatory lesions and myelopathy were more frequent in those attributed according to AA. 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 a more favorable clinical outcome, as indicated by the Likert scale. <h3>Conclusion:</h3> Cerebral atrophy was negatively associated with attribution to SLE according to CJ, while inflammatory lesions and myelopathy were positively associated with attribution according to AA. These findings support the role of bMRI in supporting attribution in NPSLE patients <h3>REFERENCES:</h3> [1] Bortoluzzi A, Scirè CA, Bombardieri S, Caniatti L, Conti F, De Vita S, Doria A, Ferraccioli G, Gremese E, Mansutti E, Mathieu A, Mosca M, Padovan M, Piga M, Tincani A, Tola MR, Tomietto P, Valesini G, Zen M, Govoni M; Study Group on Neuropsychiatric Systemic Lupus Erythematosus of the Italian Society of Rheumatology. Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatology (Oxford). 2015 May;54(5):891-8. doi: 10.1093/rheumatology/keu384. Epub 2014 Oct 21. PMID: 25339643. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>