Ces radiol. 2011, 65(3):229-233

Morphological findings in neurolupus patients with symptomatic strokeOriginal article

Věra Peterová¹, Miroslav Kron¹, Antonie Vojtěchová¹, Kamila Peterová¹, Ctibor Dostál², DanaTegzová², Radka Svobodová²

¹ MR oddělení Radiodiagnostické kliniky 1. LF UK a UK, Praha

² Revmatologická klinika 1. LF UK a UK, Praha

Aim: The aim of the study was to evaluate the findings of magnetic resonance (MR) in patients with neuropsychiatric lupus erythematosus (NPSLE) with symptomatic stroke.

Methods: The cohort of patients was created from 10 NPSLE patients with symptomatic stroke out of total 60 NPSLE patients (9 females, 1 male of the age 20-55 years), which were investigated on spiral CT and 1.5T MR. CT investigation was performed in spiral mode without contrast application. MR investigation included: pre- and post-contrast T1 weighted images (T1WI) with and without magnetization transfer (MT), T2 weighted images (T2WI) and flow attenuated inversion recovery (FLAIR) in axial and sagittal, 3mm and 6mm slices.

Results: In patients with symptomatic strokes three major types of focal abnormalities were seen on the T2WI: 1. wedge-shaped hyperintense corticol-subcortical foci > 6 mm correlated to postmalatic pseudocysts were present in 42.1% of patients; 2. smaller hyperintense multifocal foci < 6 mm with diffuse distribution, predominantly in the subcortical region in frontal and parietal lobes corresponding to microinfarcts, which were present in all NPSLE patients; 3. hyperintense areas > 6 mm diffusely spread in the grey and white matter representing edema were observed in 10.5% of patients. Metabolically active foci hypersignal on T1WI with MT were observed in 37% of patients. The postmalatic lesions in MR were distributed predominantly in the territory of arteria cerebri media (ACM). The blood brain barrier disruption was not present in our patients. Various degree of cerebral atrophy was observed in 57.9% patients.

Conclusion: Strokes were represented in clinical neuropsychiatrical symptomatology in 31.7% of our NPSLE patients. The MRI findings seen in the NPSLE patients with symptomatic stroke did not significantly differ from those seen in NPSLE patients with other clinical neuropsychiatric symptoms. Postmalatic lesions were observed only in 42.1% of our stroke patients, most often in supratentorial regions, usually in vascular borderlands and ACM territory prevailed. Small focal lesions up to 6mm are similar to NPSLE patients with any clinical symptomatology including strokes and 3mm size usually prevails.

Keywords: neuropsychiatric lupus, stroke, magnetic resonance

Grants and funding:

Práce vychází z výzkumných záměrů MZO 00064165 a 000 000 23728.

Accepted: July 15, 2011; Published: September 1, 2011  Show citation