Assessing grey matter structural alterations in systemic lupus erythematosus using synthetic MRI.

Objectives: To assess brain grey matter alterations in patients with SLE and their correlation with neuropsychological testing using synthetic MRI (SyMRI).

Methods: This prospective study enrolled patients with SLE and age, gender and education-matched healthy controls (HC). Study assessments included brain MRI using SyMRI and neuropsychological tests: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span Test, Self-Rating Anxiety Scale and Self-Rating Depression Scale (SDS). SyMRI post-processing and Automated Anatomical Labeling were used for grey matter mapping. Correlation analysis was performed to assess the relationship between brain grey matter structural alterations and neuropsychological testing.

Results: 77 patients with SLE (57 non-neuropsychiatric SLE (non-NPSLE), 20 NPSLE) and 29 HC participants were enrolled. Patients with SLE showed reduced grey matter volume compared with HC (p<0.05). The NPSLE group exhibited more extensive increases in longitudinal (T1) and transverse (T2) relaxation times in grey matter than the non-NPSLE group (p<0.001). Proton density values were lower in patients with SLE (p<0.001). Lower brain parenchymal volume correlated with higher SLE Disease Activity Index (p<0.05). Lower MMSE/MoCA scores correlated with increased T1/T2 in the left medial cingulate and paracingulate gyri (p<0.05). Higher SDS scores correlated with increased T1/T2 in the left calcarine fissure and surrounding cortex (p<0.05). These changes were also linked to disease markers (C3, C4, immunoglobulin M, erythrocyte sedimentation rate) (p<0.05).

Conclusions: Grey matter alterations in patients with SLE correlate with cognitive impairment, depression and disease activity.