MRI in SLEMagnetic Resonance Imaging and Brain Histopathology in Neuropsychiatric Systemic Lupus Erythematosus
Section snippets
Study Design
This study was approved by the institutional review board and complied with the Declaration of Helinski. Each participant provided a priori written informed consent for both the clinical studies and the postmortem autopsy. The diagnosis of systemic lupus erythematosus (SLE) was established in each subject using the American Rheumatism Association 1982 and American College of Rheumatology (ACR) 1997 revised criteria for SLE (17, 18). A rheumatologist confirmed the diagnosis of SLE after an
Results
Summary demographic and clinical data are included in Table 1 and SLE-related antibody data are included in Table 2. MRI and histopathologic findings are summarized in Table 3. Examples of paired MRI and histopathologic findings are shown in Figure 1, Figure 2, Figure 3, Figure 4, Figure 5, Figure 6, Figure 7, Figure 8, Figure 9. The most common premortem MRI findings in fatal NPSLE were small focal white matter lesions (seen in 100% of subjects), moderate to severe cortical atrophy (64%),
Discussion
There are a number of prior paired MRI-autopsy case reports and a few classic SLE autopsy series (26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42). However, this is the first prospective study of NPSLE to systematically examine the histopathologic basis for the MRI findings in NPSLE by comparing premortem MRI with histopathology at autopsy (Table 3, Table 4).
The present study demonstrates that thromboembolism and hypercoagulability are dominant mechanisms for fatal NPSLE and
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This work was supported by research grants from the US National Institutes of Health including R01 HL077422-01-A3 to Dr. Roldan, R01 NS039123 to Dr. Brooks, and R01 NS035708 to Dr. Sibbitt.