Diffusion tensor imaging in patients with acute onset of neuropsychiatric systemic lupus erythematosus: A prospective study of apparent diffusion coefficient, fractional anisotropy values, and eigenvalues in different regions of the brain

Purpose: To investigate whether apparent diffusion coefficient (ADC), fractional anisotropy (FA), and eigenvalues in neuropsychiatric systemic lupus erythematosus (NPSLE) patients differ from those of healthy controls. Material and Methods: Eight NPSLE patients (aged 23-55 years, mean 42.9 years) and 20 healthy age-matched controls (aged 22-59 years, mean 44.4 years) underwent conventional brain magnetic resonance (MR) and diffusion tensor imaging (DTI). The ADC, FA, principal eigenvalue (lambda(parallel to)), and the corresponding average perpendicular eigenvalue (lambda(perpendicular to)) (=(lambda(2)+lambda(3))/2) were measured in selected regions of normal appearing gray and white matter brain parenchyma. For statistical evaluation of differences between the two groups, a Student's t-test was used. The P value for statistical significance was set to P = 0.0025 after Bonferroni correction for multiple measurements. Results: Significantly increased ADC values were demonstrated in normal-appearing areas in the insular cortex (P < 0.001), thalamus (P < 0.001), and the parietal and frontal white matter (P < 0.001 and P < 0.001, respectively) in NPSLE patients. Significantly decreased FA values were demonstrated in normal-appearing thalamus (P < 0.001), corpus callosum (P = 0.002), and in the parietal and frontal white matter (P < 0.001 and P < 0.001, respectively) in NPSLE patients compared to healthy controls. The lambda(perpendicular to) was significantly higher in several of these regions in NPSLE patients compared to healthy controls. Conclusion: Our study demonstrates alterations in normal-appearing gray and white matter brain parenchyma of patients with NPSLE by means of abnormal ADC, FA, and eigenvalues. These alterations may be based on loss of tissue integrity in part due to demyelination. It is possible that DTI in the future could assist in the diagnosis of NPSLE and possibly help to further elucidate the pathogenesis of NPSLE.