Future Perspectives in the Diagnosis of Neuropsychiatric Lupus by Advanced Magnetic Resonance Imaging Techniques

Neuropsychiatric (NP) syndromes are an important cause of morbi-mortality in patients with Systemic Lupus Erythematosus (SLE). Despite remarkable recent progress, there are no definite methods to diagnose neuropsychiatric SLE (NPSLE) or to differentiate primary NPSLE from secondary causes. NPSLE remains a diagnosis of exclusion, and the clinical judgment is still the main approach to the correct diagnosis. Within this complex context, the Magnetic Resonance Imaging (MRI) has both a diagnostic role, by showing the nervous system involvement on one hand and excluding other causes on the other hand, and a prognostic role, help in assessing the lesions and monitoring the evolution. Conventional MRI shows brain involvement in around half of the patients, although the described findings are rather non-specific and present in many other diseases. However, many advanced MRI techniques are becoming increasingly used over the last period, showing abnormalities even in normal-appearing brains on conventional MRI. These MRI techniques hold promise to have a higher sensitivity and specificity than conventional MRI for NPSLE related changes. This review explores the place and the future perspectives of different advanced MRI techniques in NPSLE.