Association of Blood-Brain Barrier Function With Disease Activity and Cognitive Function in Systemic Lupus Erythematosus Patients

J Magn Reson Imaging. 2025 Oct 4. doi: 10.1002/jmri.70143. Online ahead of print.

ABSTRACT

BACKGROUND: Disruption of the blood-brain barrier (BBB) is an important mechanism in the pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE), potentially influencing disease progression and cognitive function.

PURPOSE: To investigate voxel-wise BBB permeability differences among NPSLE, non-NPSLE, and healthy controls (HC) using dynamic contrast-enhanced MRI (DCE-MRI), and explore associations with disease activity and cognitive function.

STUDY TYPE: Multicenter, cross-sectional study.

SUBJECTS: 22 NPSLE patients, 24 non-NPSLE patients, and 27 age- and sex-matched HC.

FIELD STRENGTH/SEQUENCE: 3.0 Tesla, GE: 3D T1-FSPGR, DCE-LAVA-Flex sequences; Philips: 3D T1-FFE, eTHRIVE sequences.

ASSESSMENT: Post-processing of DCE-MRI images was conducted to calculate the volume transfer constant (K^trans) and plasma volume fraction (V_p) maps, which were transformed to Montreal Neurological Institute space. Brain regions were defined using the Anatomical Automatic Labeling (AAL) atlas. Group differences among NPSLE, non-NPSLE, and HC were assessed. Mean K^trans/V_p values from suprathreshold clusters were evaluated for associations with the Disease Activity Index (SLEDAI) and Montreal Cognitive Assessment (MoCA) scores. Mean K^trans/V_p from corresponding AAL regions was extracted for further validation of the observed correlations.

STATISTICAL TESTS: Voxel-wise ANOVA with Tukey’s HSD test; Spearman correlation and linear regression. Threshold: Voxel-wise p < 0.001, cluster size > 20; group comparisons p < 0.05.

RESULTS: A significantly elevated K^trans was observed in the right caudate of NPSLE patients compared to non-NPSLE patients, and hippocampal K^trans was significantly higher in NPSLE than both non-NPSLE and HC. Both NPSLE and non-NPSLE patients exhibited widespread significant increases in V_p compared to HC. In the entire SLE cohort, right caudate K^trans was positively associated with SLEDAI (ρ = 0.43, R² = 0.18) and negatively associated with MoCA scores (ρ = -0.35, R² = 0.12) after adjusting for confounding factors.

DATA CONCLUSION: This study provided voxel-level evidence linking regional BBB leakage to both disease activity and cognitive impairment in SLE.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

PMID:41045050 | DOI:10.1002/jmri.70143