Magnetic resonance imaging of the brain and cerebral proton spectroscopy in patients with systemic lupus erythematosus

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Abstract
Objective. To investigate the prevalence and extent of cerebral changes in patients with systemic lupus erythematosus (SLE) by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Methods. SLE patients (47 women) and controls (25 women) underwent 1.5T MRI. A semiautomated segmentation technique calculated cerebrospinal fluid (CSF) and brain volumes. Proton MRS of the frontal and parieto‐occipital white matter yielded metabolite ratios of N‐acetyl groups (NA), choline, and creatine. Results. Compared with the control group, the SLE patients more often had cerebral atrophy on MRI (32% versus 0%), confirmed by an increase in the CSF to intracranial volume ratio. The patients also had old infarcts and hemorrhages (8.5% versus 0%) and more small white matter lesions (23% versus 8% had > 5 such lesions). MRS showed relative reduction of NA peaks. Although no patient was studied when acutely ill, prior neurologic involvement was related to abnormal findings. Conclusion. MRI and MRS are helpful in the investigation of cerebral complications of SLE. There are chronic changes which may be ischemic in nature. Their precise cause, consequences, and prevention are current challenges.