Purpose or Case Report: Systemic lupus erythematosus (SLE) is a generalized autoimmune connective tissue disease which can cause white-matter micro-architectural changes in the central nervous system. Further, involvement appears to be independent of the presence or absence of neuropsychiatric symptoms. However, these findings have largely been elucidated in adults with an overall paucity of data regarding white-matter micro-architectural changes in the pediatric SLE population. The purpose of this study is to objectively identify the presence of white-matter micro-architectural changes in pediatric patients with SLE compared to age-matched healthy controls.
Methods & Materials: Magnetic resonance diffusion tractography (DTI) data was retrospectively obtained from a single institution in a total of 11 SLE pediatric patients (mean age 14.8 years) and 25 healthy, age-matched controls (mean age 14.5 years). Age range for both SLE patients and healthy control patients was 10-19 years. All patients were scanned on a 3T Skyra/VIDA (Siemens, PA, USA) scanner. Specific parameters included GR single shot EPI sequences with spatial resolution of 1.25x1.25x2.5, TR of 5000 ms, TE of 100 ms, 1 b0 and 20 diffusion gradient directions with the b-value of 1000 s/mm^2, repeated twice. Tract-based spatial statistics (TBSS) analysis was performed and the fractional anisotropy (FA), mean diffusivity (MD), axonal diffusivity (AD), and radial diffusivity (RD) was compared between the two groups using a threshold-free cluster enhancement. Multiple comparison corrected 1-p value maps were generated for FA, MD, AD, and RD following multiple comparison correction of the p-values.
Results: Compared to healthy, age-matched controls, patients with SLE demonstrated statistically significant lower FA in the corpus callosum, bilateral frontal subcortical white matter, and bilateral centrum semiovale. Further, statistically significant increase in radial diffusivity was identified in the corpus callosum, left frontal and parietal subcortical white matter, and left centrum semiovale in SLE patients compared to healthy, age-matched controls.
Conclusions: Pediatric patients with SLE and otherwise normal brain MRI’s demonstrate micro-architectural changes in select regions of white matter compared to healthy, age-matched control patients.