Brain MRI Study Uncovers Potential Small-Vessel Disease Burden in Systemic Sclerosis

Deep white-matter hyperintensities (DWMH) on brain magnetic resonance imaging were significantly more prevalent and more extensive among individuals with systemic sclerosis (SSc) vs matched healthy controls, pointing to possible cerebral small-vessel disease among this patient population, according to study results published in Rheumatology.

Central nervous system manifestations are increasingly being recognized in SSc. White-matter hyperintensities — especially the ischemic DWMH subtype— are well-established radiological markers of small-vessel disease, yet their distribution and burden in SSc have not been comprehensively mapped.  

To explore this, investigators at a single tertiary center prospectively enrolled 84 adults with SSc (mean age, 47.1±11.4 years; 86.9% women) and 30 age- and sex-matched controls. All patients underwent high-resolution 3D T1-weighted and T2 Fluid Attenuated Inversion Recovery imaging.

Whole-white-matter (WWM) volume was quantified with automated software, while 2 blinded neuroradiologists manually delineated periventricular (PVH) and deep DWMH regions; lesion volumes were expressed as a fraction of WWM.

Any WMH was detected among 79.8% of patients with SSc vs 60.0% of controls (P =.033). Median DWMH-to-WWM volume was 2.28 × 10^-4 (IQR, 0.35-9.68 × 10^-4) among the SSc group — 2.5-fold higher than the volume found among controls (0.91 × 10⁻⁴; IQR, 0-3.31 × 10⁻⁴; P =.0339). Deep WMH also constituted a larger share of total WMH among patients with SSc (P =.0066).

Age and hyperlipidemia independently predicted WMH, whereas erythrocyte sedimentation rate and gastroesophageal reflux lost significance after adjustments.

Results of cutaneous subtype analyses showed that patients with diffuse-cutaneous SSc (n=37) carried a higher corrected PVH-to-WMH volume residual than those with limited-cutaneous disease (median, 0.06 vs -0.16; P =.0346); DWMH volume did not differ and the association weakened after controlling for confounding factors.

Neuropsychiatric screening revealed high rates of anxiety (39.76%), depression (50.60%), and cognitive impairment (38.55%), yet none of these factors were correlated with WMH metrics after adjustment.

Study limitations include the cross-sectional, single-center design, the small number of controls, and potential confounding from vasoactive drug use and vascular risk factors.

“Cognitive dysfunction and emotional symptoms (anxiety/depression) were not proven to be associated with white matter alterations in our SSc patient cohort in this study,” the researchers concluded.

This article originally appeared on Rheumatology Advisor