Intracranial vessel wall MRI in ischemic stroke in systemic lupus erythematosus: radiological characteristics and clinical associations.

Background: The morphology of intracranial vessel wall lesions (VWLs) in systemic lupus erythematosus (SLE) has not yet been fully elucidated. This study aimed to explore the radiological characteristics of intracranial VWLs in SLE ischemic stroke patients and the relationship between these characteristics and clinical features using high-resolution vessel wall imaging (HRVWI). Methods: This cross-sectional study evaluated the distribution and patterns of intracranial VWLs in SLE ischemic stroke patients, and individually age- and sex-matched control ischemic stroke patients without autoimmune diseases. A univariate analysis was performed to compare the clinical and radiological characteristics between the different patients and the VWL patterns. A follow-up study of HRVWI was carried out where data were available. Results: A total of 30 SLE patients (9 males) with a mean [± standard deviation (SD)] age of 42.0±13.1 years were enrolled in the study. In total, 68 segment VWLs in 25 SLE patients were found. Concentric thickening and enhancement (CTE) (n=50) and eccentric thickening and enhancement (ETE) (n=18) were the two main VWL patterns. In total, 76 VWLs were found in the control group, all of which were ETE lesions. The percentage of culprit VWLs (90.0% vs. 88.9% vs. 69.7%, P=0.013) and the distribution of the VWLs in the internal carotid artery (ICA; 60.0% vs. 5.6% vs. 19.7%, P<0.001), middle cerebral artery (MCA; 18.0% vs. 61.1% vs. 52.6%, P<0.001), and vertebral artery (VA) (0% vs. 11.1% vs. 13.2%, P=0.013) differed significantly among the SLE-CTE, SLE-ETE, and control VWLs, mostly due to the difference between the SLE-CTE and control VWLs. The SLE patients with CTE patterns had a higher systemic lupus erythematosus disease activity index (SLEDAI) score (P=0.003), a lower percentage of lupus nephritis (LN) (P=0.015), and more VWL segments (P=0.010) than the SLE patients with ETE patterns. In total, 11 patients were followed up for 8.36±5.0 months. No new VWLs were found. Most VWLs (28/37) remained stable without significant improvement. Conclusions: HRVWI highlights the frequent occurrence of VWLs in large- and medium-sized intracranial arteries in SLE ischemic stroke patients. The two main VWL patterns were CTE and ETE lesions, which represented vasculitis and atherosclerosis, respectively, and which were associated with disease activity and LN. The VWLs rarely disappeared even in patients who received combined therapy for several months.