Magnetic Resonance Imaging Study Of Cerebral Metabolism And Cerebral Blood Perfusion In Patients With Systemic Lupus Erythematosus

Objective:Multi-voxel ~1H magnetic resonance spectroscopy(~1H-MRS)combined with3D arterial spin labeling(3D-ASL)To quantitatively evaluate brain metabolites and cerebral blood flow in systemic lupus erythematosus(SLE)patients without obvious neuropsychiatric symptoms,and to explore the correlation between them and their correlation with cognitive function.Methods:This study was a prospective cross-sectional study.From January 2022 to November 2022,19 female SLE patients without obvious neuropsychiatric symptoms(SLE group)and 14 age-matched female healthy volunteers(control group)were recruited.Each subject underwent conventional brain MRI,3D-ASL,multi-voxel ~1H-MRS scan and neuropsychological scale examination.The questionnaire included Montreal Cognitive Assessment(MoCA),self-rating anxiety scale(SAS)and self-rating depression scale(SDS).The mean cerebral blood flow(CBF)and the ratios of brain metabolite concentrations(including NAA/Cr,Cho/NAA and Cho/Cr)in the bilateral semioval center(SOC),lentiform nucleus(LN)and dorsal thalamus(DT)were measured.Two independent sample t test was used to compare the difference of metabolite concentration ratio and average CBF value in each brain region between the two groups.Pearson correlation analysis was used to explore the correlation between metabolite concentration ratio and average CBF value in brain regions with significant differences,and to analyze the correlation between them and cognitive function.Results:(1)The MoCA score of SLE group was lower than that of control group(P=0.001),while there was no significant difference in SAS and SDS scores between SLE group and control group(P>0.05).(2)Compared with the control group,the CBF values of SOC,LN and DT in the SLE group decreased(All P<0.05).(3)The SLE group’s NAA/Cr values of bilateral SOC and right DT were lower than those of the control group(All P<0.05).In contrast,NAA/Cr in other brain regions in the SLE group had a tendency to decrease,yet the difference was not statistically significant(P>0.05).The left SOC Cho/Cr value in the SLE group was greater than that of the control group(P<0.05),and the Cho/Cr in other brain regions showed a growing trend,yet the disparity was not statistically significant(P>0.05).The SLE group’s Cho/NAA values of Bilateral SOC,LN and DT were greater than those of the control group(All P<0.05).(4)A positive correlation between MoCA score and NAA/Cr values of bilateral SOC was observed(right r=0.471,P=0.042;Left r=0.476,P=0.040).The Cho/NAA value of the right LN was negatively correlated with the mean CBF value(r=-0.639,P=0.003),and the Cho/NAA value of the right DT was negatively correlated with the mean CBF value(r=-0.547,P=0.015).Conclusion:There are abnormal cerebral metabolism and cerebral blood perfusion in normal brain tissue of SLE patients without obvious neuropsychiatric symptoms,which are related to cognitive decline.Multimodal magnetic resonance imaging study is helpful to understand the pathological mechanism of brain damage in SLE patients from different perspectives,and is helpful to find the correlation between different pathological mechanisms.