A study on brain microstructural changes in systemic lupus erythematosus patients using tract-based spatial statistics

SUN Zhongru; XIA Jianguo; LI Yifan; WANG Ning; TIAN Weizhong; ZOU Hongmei

doi:10.19300/j.2025.L21378

Abstract：Objective To investigate differences in white matter microstructure between patients with neuropsy-chiatric systemic lupus erythematosus(NPSLE)and those with non-neuropsychiatric SLE(Non-NPSLE)using tract-based spatial statistics(TBSS).Methods A total of 34 NPSLE patients and 32 Non-NPSLE patients were prospectively enrolled,along with 33 healthy controls(HC)during the same period.All participants underwent brain diffusion tensor imaging(DTI).TBSS was used to compare white matter microstructural differences among the three groups.Fractional anisotropy(FA)values were compared using one-way ANOVA,with post hoc analyses conducted for pairwise group comparisons.Partial correlation analyses assessed the relationships between FA values of significantly different clusters and neuropsychological scores or clinical indicators,as well as the correlations between neuropsychological scores and clinical indicators.Results Five clusters showed significant FA differences among the three groups(P<0.05,FWE-corrected).Post hoc analysis revealed that two clusters in both the Non-NPSLE and NPSLE groups had lower FA values than the HC group,and one cluster in the NPSLE group had a lower FA value than the Non-NPSLE group(P<0.05,FWE-corrected),indicating more extensive white matter involvement in NPSLE.FA reductions in SLE patients were primarily located in the corpus callosum and corona radiata.Correlation analysis showed that FA values of the significant clusters in pairwise comparisons were positively correlated with IgM levels(P<0.05).In the NPSLE group,HADS-D scores were negatively correlated with C4 levels(r=-0.354,P=0.047),while in the Non-NPSLE group,MoCA scores were negatively correlated with ESR(r=-0.424,P=0.019).Conclusion NPSLE patients exhibit more extensive white matter microstructural damage compared to Non-NPSLE patients.The FA values of some differential clusters correlate with clinical indicators,suggesting that these changes may serve as important imaging biomarkers for detecting disease activity or neuropsychiatric involvement in SLE.