Background: Although clinical
assessment is still the cornerstone in the diagnosis of neuropsychiatric SLE
(NPSLE), the diagnosis is often difficult. Proton magnetic spectroscopy
(1H-MRS) has the ability to detect neurochemical brain abnormalities even in
normal MRI areas in these patients. Objective: To evaluate the spectral
brain changes using 1H-MR spectroscopy in NPSLE patients, and correlate their
NP clinical data with MRI and 1H-MRS
abnormalities. Methods: 23
NPSLE patients and 8 healthy controls were included in this study.
Neuropsychological tests were applied to all patients and controls for
detection of impairment in any cognitive domains. Patients were classified into
two groups; the first included NPSLE patients with normal MRI, while the other
group with abnormal MRI. Single voxel proton MRS using point resolved
spectroscopy sequence were evaluated in the parieto-occipital white matter in
all patients and volunteers and in areas of MRI abnormal lesions. The relative
ratios of NAA to Cr and Cho to Cr were measured. Results: Patients age ranged
from 18-36, with mean±SD was 26.45±5.65 years, the most common NP features were
headache and cognitive impairment with 39.1% for each of them, 9 patients
(39.1%) had abnormal MRI imaging, while, spectral changes present in 20
patients (86.9%). MRS showed a significantly decreased NAA/Cr ratio and
increased Cho/Cr ratio. In patients with abnormal MRI, the NAA/Cr ratio was
significantly lower than those with normal MRI and control groups while the
Cho/Cr ratio was significantly higher. Conclusion: In patients with NPSLE, 1H-MR
spectroscopic findings seem to reflect the cerebral metabolic disturbances as
functional abnormalities, related to the NP symptoms and it is a complementary
tool to MRI as anatomical abnormalities in diagnosing the CNS involvement. [Egypt J Neurol Psychiat
Neurosurg. 2011; 48(4): 359-366]
Key
Words: neuropsychiatric manifestations, systemic
lupus erythematosus, MRI, 1H-MRS.
Correspondence to: Heba Selim, Department of Neurology,
Zagazig University, Egypt.
Tel.: +20128310090. E-mail: Habhoob_444@hotmail.com.