Imaging therapeutic response at brain neuroimmune interfaces in women with systemic lupus erythematosus

Purpose Systemic lupus erythematosus (SLE) frequently affects the central nervous system, likely via neuroimmune interfaces; how these interfaces respond longitudinally to standard therapy remains unclear. This study aimed to clarify these therapeutic dynamics. Methods This retrospective longitudinal study included 63 women with SLE who had brain MRI at baseline and after standard therapy. Enlarged perivascular spaces (ePVS), choroid plexus (CP), and gray matter (GM) volumes were segmented from 3D T1-weighted images; the diffusion tensor imaging along the perivascular space (DTI-ALPS) index was computed from DTI scans. Paired t-tests compared baseline and post-therapy values. Patients were grouped into neuropsychiatric SLE (NPSLE) and non-NPSLE groups, and longitudinal deltas compared. Spearman correlations assessed associations of MRI changes with clinical measures. Results After standard therapy, all 63 patients showed clinical improvement (decreased SLEDAI-2K, increased MoCA scores). Left DTI-ALPS index increased (T = -2.475, P FDR = 0.048), and bilateral CP volumes decreased (left: T = 2.432, P FDR = 0.048; right: T = 3.330, P FDR = 0.006). ePVS volumes remained unchanged. No significant correlations emerged between MRI changes and clinical scores, and improvement did not differ between NPSLE and non-NPSLE subgroups. Conclusions Longitudinal MRI identified measurable alterations in Neuroimmune Interfaces in women with SLE, particularly the DTI-ALPS index and CP volume. These changes correlate with clinical improvement and serve as supplementary imaging biomarkers for assessing disease activity, independent of neuropsychiatric involvement.