关键词: 狼疮血管炎, 中枢神经系统, 磁共振成像, 自身抗体, 预后

Abstract: Abstract:Objective  To investigate the correlation between cranial magnetic resonance imaging (MRI) findings and autoantibody levels  in patients with neuropsychiatric systemic lupus erythematosus (NPSLE),and to elucidate the role of MRI findings in predicting the prognosis of NPSLE.
Methods In total,36 well-documented cases of NPSLE diagnosed definitely were selected.All the patients were divided into survival group (n=27) and
 dead group (n=9).Anti-nuclear antibodies and anti-dsDNA antibodies in serum were detected by indirect immunofluorescence and colloidal gold spot penetration method, respectively.Immunoblotting method was used to detect anti-Sm,anti-SSA,anti-SSB,anti U1-RNP, and anti-ribosomal P protein antibodies.Anti-cardiolipin antibody (ACL) was detected by ELISA method.The correlation between MRI findings of cerebral lesions and  autoantibodies,and prognosis was analyzed. Results  Cranial MRI scans on admission were abnormal in 32 patients (88.9%),among which 21 cases showed diffuse manifestations,10 cases showed focal lesion in brain and 1 case showed brain atrophy.The diffuse lesion on MRI showed multiple spotty or patchy normal intensity signal on T1-weighted image (T1WI) and high-intensity signal changes on T2-weighted image (T2WI).The focal lesion showed single spotty or patchy normal intensity signal on T1WI and high-intensity signal changes on T2WI.Thelesion sites included basal ganglia,subcortical white matter,anterior and posterior horn of lateral ventricle,semiovale center,cerebral cortex,brainstem and cerebellum.Of 9 patients in dead group,6 cases presented with focal lesion and the percentage of focal lesion cases in dead group was significantly higher than that in survival group (P<0.01).The percentages of lesion number in brainstem and basal ganglia in dead group were 11.5% and 26.9%, respectively,which were significantly higher than those in survival group (P<0.05 or P<0.01).The positive rate of ACL in cases with focal lesion was higher than that in cases with diffuse lesion (P<0.05).
Conclusion  NPSLE patients with focal lesion,brainstem and basal ganglia involvement on cranial MR images show an unfavorable outcome.
ACL is associated with focal lesion. There is a certain correlation between MRI findings and autoantibodies in patients with NPSLE.MRI findings may help to  predict the prognosis of NPSLE to some extent.

Key words: lupus vasculitis,central nervous system, magnetic resonance imaging, autoantibodies, prognosis