Intracranial vessel wall enhancement scoring system for monitoring disease activity and neuropsychiatric impairment in systemic lupus erythematosus.

OBJECTIVES

To establish an intracranial vessel wall enhancement (VWE) scoring system and evaluate its potential as a protocol for monitoring systemic lupus erythematosus (SLE) disease activity and neuropsychiatric impairment.

MATERIALS AND

METHODS

In this retrospective study, fifty patients with SLE underwent conventional MRI and high-resolution magnetic resonance vascular wall imaging (HR-VWI) at three tertiary hospitals between August 2022 and December 2023. We analyzed VWE distribution in intracranial arteries, developed a scoring system based on enhancement patterns, and examined the relationship between VWE scores, disease activity, and cognitive function. Univariate analysis and logistic regression were utilized to identify clinical and imaging characteristics associated with sustained lupus low disease activity state (LLDAS) and central nervous system (CNS) neuropsychiatric impairment.

RESULTS

SLE patients exhibited multi-segmental intracranial vessel wall thickening with concentric or double-track enhancement. VWE scores positively correlated with disease activity and negatively with cognitive function (both P < 0.001). High VWE scores was negative predictors for achieving sustained LLDAS (OR, 1.52; 95 % CI: 1.01-2.28; P = 0.043). Logistic regression confirmed VWE scores as independent predictors of CNS neuropsychiatric impairment (OR, 1.92; 95 % CI: 1.03-3.60; P = 0.04). A VWE score > 4.0 demonstrated high sensitivity (96 %) and moderate specificity (65 %) for diagnosing CNS impairment (AUC = 0.82; P < 0.001).

CONCLUSION

The VWE scores system can serve as a valuable protocol for monitoring disease activity and detecting CNS neuropsychiatric impairment in SLE, offering a potential tool for early diagnosis and prognosis evaluation.