Evaluation of brain changes in systemic sclerosis (SSc) patients using two different techniques of MRI: Is it really worthy?

Rania M Gamal; Abeer M Ghandour; Mohamed Zidan; Marwa A A Galal

doi:10.1016/j.reuma.2019.07.001

Evaluation of brain changes in systemic sclerosis (SSc) patients using two different techniques of MRI: Is it really worthy?

Reumatol Clin (Engl Ed). 2021 Mar;17(3):132-136. doi: 10.1016/j.reuma.2019.07.001. Epub 2019 Sep 17.

[Article in English, Spanish]

Authors

Rania M Gamal¹, Abeer M Ghandour¹, Mohamed Zidan², Marwa A A Galal³

Affiliations

¹ Rheumatology, Rehabilitation and Physical Medicine Department, Assiut University Hospitals Faculty of Medicine, Assiut University, Egypt.
² Radiodiagnosis Department, Assiut University Hospitals Faculty of Medicine, Assiut University, Egypt.
³ Rheumatology, Rehabilitation and Physical Medicine Department, Assiut University Hospitals Faculty of Medicine, Assiut University, Egypt. Electronic address: marwa.a.galal@aun.edu.eg.

PMID: 31537453
DOI: 10.1016/j.reuma.2019.07.001

Abstract

Background: Systemic sclerosis (SSc) is a rare chronic multi-system autoimmune disease of unknown cause and a complex pathogenesis. The hallmark of the disease is microvascular vasculopathy which results in tissue ischemia with recurrent episodes of reperfusion. Diffusion-weighted (DW) Magnetic Resonance imaging (MRI) is an excellent tool for the detection of activity of any vascular or inflammatory lesions.

Objectives: Detect brain changes in systemic sclerosis patients with asymptomatic CNS manifestations using fluid attenuation inversion recovery (FLAIR) weighted sequence and diffusion-weighted (DW) sequence MRI.

Methods: Fifteen systemic sclerosis female patients aged 27-60 years old with disease duration of 1-20 years with no CNS clinical manifestations were included. A controlled group of 14 clinically normal persons, age and sex matched. Both groups were subjected to brain MR examination at 1.5T; a FLAIR weighted sequence and a DW sequence. SPSS (version 20) was used for statistical analysis.

Results: 37 white matter hyperintense lesions (≤2 to ≥ 5mm in diameter) were detected in patient group using FLAIR weighted MRI while diffusion-weighted MRI failed to detect the same lesions. A non-significant relation (P=.259) between the presence of white matter hyperintense lesions and the severity of peripheral vascular affection of the disease was observed.

Conclusions: Asymptomatic central nervous system vasculopathy is detected in systemic sclerosis using FLAIR MRI, while diffusion MRI failed to detect such lesions. These findings suggest a non-inflammatory form of central nervous system microvasculopathy in SSc patients.

Keywords: Hallazgo cerebral de esclerosis sistémica; Resonancia magnética del cerebro de esclerosis sistémica; Resonancia magnética del cerebro de esclerosis sistémica versus difusión de la resonancia magnética; SSc Brain FLAIR MRI; SSc Brain FLAIR versus Diffusion MRI; SSc brain finding.