MR in neurological syndromes of connective tissue diseases.

Background: Neurological complications in the course of SLE are mostly associated with vascular changes. An important role in their pathogenesis is played by immune mechanisms. The aim of the study was to determine the value of modern imaging techniques, with special reference to selected MR sequences (FLAIR, DWI) in the diagnosis of cerebral changes in patients with neurological symptoms of SLE.

Material/methods: Fifty patients with neurological symptoms of SLE underwent CT and MR of CNS in routine sequences. In 12 cases EPI DWI sequences were also performed. Serum levels of antinuclear, anti-native DNA and antiphospholipid antibodies were also determined.

Results: The changes in CNS were detected in 48 patients in MR and in 42 patients in CT. Focal changes were observed in 29 cases, while atrophic changes were seen in the majority of subjects. In 10 cases, DWI showed changes typical for acute stroke. The extend and advancement of changes in CT and MR correlated with the severity of neurological symptoms; there was also a correlation between the changes and elevated levels of antiphospholipid antibodies. FLAIR was useful in the detection of gliosis and cortical scar, while DWI enabled us to detect acute ischaemic foci and to distinguish them from coexistent scars.

Conclusions: MRI with FLAIR and DWI sequences enhances the sensitivity and specifity of neuroimaging techniques in the diagnosis of neuropsychiatric disease in SLE. There is a correlation between elevated titre of antiphospholipid antibodies and the presence of vascular changes in patients with neurological manifestations of SLE.