Altered patterns of cerebral perfusion in systemic lupus erythematosus patients with cognitive dysfunction, pain and fatigue.

Motivation: Cognitive dysfunction (CD), fatigue and pain are common and debilitating in systemic lupus erythematosus (SLE). Symptom-based neuroimaging could contribute to pathophysiological models and patient-centered care. Goal(s): Investigating brain perfusion and blood-brain barrier permeability in SLE patients with CD, fatigue and pain. Approach: 66 SLE patients underwent 3T dynamic susceptibility contrast (DSC) MRI. The leakage parameter K2 and normalized leakage corrected perfusion parameters were estimated in 14 brain regions, compared by symptomatology. Results: Patients with CD or fibromyalgia displayed increased cerebral blood flow and/or cerebral blood volume in regions associated with pain processing. No differences were found for fatigue, K2 or mean transit time. Impact: DSC-MRI detects cerebral hyperperfusion in systemic lupus erythematosus patients with cognitive dysfunction or the pain syndrome fibromyalgia, but not fatigue, suggesting different inflammatory or compensatory mechanisms. Investigating each of these debilitating symptoms separately might further characterize and guide patient-centered interventions.