Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective study
Objectives We aimed to investigate which elementary lesions, identified through conventional brain MRI, correlated with the attribution of neuropsychiatric (NP) manifestations of SLE as determined by clinical judgement (CJ) and a validated attribution algorithm (AA).Methods We conducted a multicentr...
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BMJ Publishing Group
2025-04-01
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| Series: | Lupus Science and Medicine |
| Online Access: | https://lupus.bmj.com/content/12/1/e001490.full |
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| author | Carlo Alberto Scirè Alessandra Bortoluzzi Marcello Govoni Matteo Piga Antonis Fanouriakis George Bertsias Greta Carrara Ettore Silvagni Enrico Fainardi Simone Appenzeller Antonio Marangoni Carlo Garaffoni |
| author_facet | Carlo Alberto Scirè Alessandra Bortoluzzi Marcello Govoni Matteo Piga Antonis Fanouriakis George Bertsias Greta Carrara Ettore Silvagni Enrico Fainardi Simone Appenzeller Antonio Marangoni Carlo Garaffoni |
| author_sort | Carlo Alberto Scirè |
| collection | DOAJ |
| description | Objectives We aimed to investigate which elementary lesions, identified through conventional brain MRI, correlated with the attribution of neuropsychiatric (NP) manifestations of SLE as determined by clinical judgement (CJ) and a validated attribution algorithm (AA).Methods We conducted a multicentre, retrospective cohort study of patients with SLE (1999–2018) from four tertiary SLE centres. Patients were assessed using American College of Rheumatology nomenclature and underwent MRI at their first NP event. NP manifestations were attributed to SLE using CJ and the AA. Elementary lesions were classified as follows: large infarcts, parenchymal haemorrhages, subarachnoid haemorrhages, inflammatory-type lesions, myelopathy, T2/fluid-attenuating inversion recovery (FLAIR) hyperintense lesions, lacunes, cerebral atrophy and microbleeds. Statistical analyses were performed using χ2 and Fisher’s exact tests. Univariable and multivariable logistic regression models were performed. A sensitivity analysis was performed using a revised AA, which excluded the item ‘presence of abnormal MRI’ from the list of favouring factors.Results Among 154 patients, 88 (57%) had NP events attributed to SLE by CJ and 85 (55%) by AA. MRI was normal in 57/154 (37%) cases, while T2/FLAIR hyperintense lesions were the most frequent findings (71/154, 46%). A normal MRI was more common in non-attributed NP events per CJ and AA (OR 0.42, 95% CI 0.21 to 0.82 and 0.27, 95% CI 0.13 to 0.52, respectively). Cerebral atrophy was more frequent in non-attributed events per CJ (adjusted OR 0.06, 95% CI 0.01 to 0.35), while inflammatory-type lesions were more prevalent in SLE-attributed events according to AA (OR 3.91, 95% CI 1.15 to 18.1), with no significant change in sensitivity analyses.Conclusions Our study elucidates the role of conventional MRI findings in the attribution process in NPSLE. The presence of selected elementary lesions or, instead, their absence could have a relevant weight in assessing NP events. These findings may assist clinicians in achieving a more accurate attribution of NP manifestations. |
| format | Article |
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| language | English |
| publishDate | 2025-04-01 |
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| series | Lupus Science and Medicine |
| spelling | doaj-art-1ca4f82ba04c43b8b6be2225808a54f32025-08-20T03:10:46ZengBMJ Publishing GroupLupus Science and Medicine2053-87902025-04-0112110.1136/lupus-2024-001490Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective studyCarlo Alberto Scirè0Alessandra Bortoluzzi1Marcello Govoni2Matteo Piga3Antonis Fanouriakis4George Bertsias5Greta Carrara6Ettore Silvagni7Enrico Fainardi8Simone Appenzeller9Antonio Marangoni10Carlo Garaffoni11Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, ItalyRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Ferrara, ItalyRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy5 Rheumatology Unit, University Clinic, AOU Cagliari; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, ItalyRheumatology and Clinical Immunology, National and Kapodistrian University of Athens, Athens, GreeceRheumatology, University of Crete School of Medicine, Iraklio, GreeceEpidemiology Unit, Italian Society for Rheumatology (SIR), Milan, ItalyRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy12 Department of Experimental and Clinical Sciences, Careggi University Hospital and University of Firenze, Florence, ItalyDepartamento de Clínica Médica, Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, BrazilRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Ferrara, ItalyRheumatology Unit, Dept. of Medical Sciences, University of Ferrara, Cona (FE), ItalyObjectives We aimed to investigate which elementary lesions, identified through conventional brain MRI, correlated with the attribution of neuropsychiatric (NP) manifestations of SLE as determined by clinical judgement (CJ) and a validated attribution algorithm (AA).Methods We conducted a multicentre, retrospective cohort study of patients with SLE (1999–2018) from four tertiary SLE centres. Patients were assessed using American College of Rheumatology nomenclature and underwent MRI at their first NP event. NP manifestations were attributed to SLE using CJ and the AA. Elementary lesions were classified as follows: large infarcts, parenchymal haemorrhages, subarachnoid haemorrhages, inflammatory-type lesions, myelopathy, T2/fluid-attenuating inversion recovery (FLAIR) hyperintense lesions, lacunes, cerebral atrophy and microbleeds. Statistical analyses were performed using χ2 and Fisher’s exact tests. Univariable and multivariable logistic regression models were performed. A sensitivity analysis was performed using a revised AA, which excluded the item ‘presence of abnormal MRI’ from the list of favouring factors.Results Among 154 patients, 88 (57%) had NP events attributed to SLE by CJ and 85 (55%) by AA. MRI was normal in 57/154 (37%) cases, while T2/FLAIR hyperintense lesions were the most frequent findings (71/154, 46%). A normal MRI was more common in non-attributed NP events per CJ and AA (OR 0.42, 95% CI 0.21 to 0.82 and 0.27, 95% CI 0.13 to 0.52, respectively). Cerebral atrophy was more frequent in non-attributed events per CJ (adjusted OR 0.06, 95% CI 0.01 to 0.35), while inflammatory-type lesions were more prevalent in SLE-attributed events according to AA (OR 3.91, 95% CI 1.15 to 18.1), with no significant change in sensitivity analyses.Conclusions Our study elucidates the role of conventional MRI findings in the attribution process in NPSLE. The presence of selected elementary lesions or, instead, their absence could have a relevant weight in assessing NP events. These findings may assist clinicians in achieving a more accurate attribution of NP manifestations.https://lupus.bmj.com/content/12/1/e001490.full |
| spellingShingle | Carlo Alberto Scirè Alessandra Bortoluzzi Marcello Govoni Matteo Piga Antonis Fanouriakis George Bertsias Greta Carrara Ettore Silvagni Enrico Fainardi Simone Appenzeller Antonio Marangoni Carlo Garaffoni Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective study Lupus Science and Medicine |
| title | Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective study |
| title_full | Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective study |
| title_fullStr | Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective study |
| title_full_unstemmed | Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective study |
| title_short | Can conventional brain MRI support the attribution process in neuropsychiatric SLE? A multicentre retrospective study |
| title_sort | can conventional brain mri support the attribution process in neuropsychiatric sle a multicentre retrospective study |
| url | https://lupus.bmj.com/content/12/1/e001490.full |
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