Diffusion kurtosis imaging (DKI) and neurite orientation dispersion and density imaging (NODDI) provide more comprehensive and informative perspective on microstructural alterations of cerebral white matter (WM) than single-shell diffusion tensor imaging (DTI), especially in the detection of crossing fiber. However, studies on systemic lupus erythematosus patients without neuropsychiatric symptoms (non-NPSLE patients) using multi-shell diffusion imaging remain scarce. Totally 49 non-NPSLE patients and 41 age-, sex-, and education-matched healthy controls underwent multi-shell diffusion magnetic resonance imaging. Totally 10 diffusion metrics based on DKI (fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity, mean kurtosis, axial kurtosis and radial kurtosis) and NODDI (neurite density index, orientation dispersion index and volume fraction of the isotropic diffusion compartment) were evaluated. Tract-based spatial statistics (TBSS) and atlas-based region-of-interest (ROI) analyses were performed to determine group differences in brain WM microstructure. The associations of multi-shell diffusion metrics with clinical indicators were determined for further investigation. TBSS analysis revealed reduced FA, AD and RK and increased ODI in the WM of non-NPSLE patients (P < 0.05, family-wise error corrected), and ODI showed the best discriminative ability. Atlas-based ROI analysis found increased ODI values in anterior thalamic radiation (ATR), inferior frontal-occipital fasciculus (IFOF), forceps major (F_major), forceps minor (F_minor) and uncinate fasciculus (UF) in non-NPSLE patients, and the right ATR showed the best discriminative ability. ODI in the F_major was positively correlated to C3. This study suggested that DKI and NODDI metrics can complementarily detect WM abnormalities in non-NPSLE patients and revealed ODI as a more sensitive and specific biomarker than DKI, guiding further understanding of the pathophysiological mechanism of normal-appearing WM injury in SLE.

中文翻译：

---

无神经精神症状的系统性红斑狼疮患者白质的微观结构变化：一项多壳弥散成像研究


与单壳弥散张量成像 （DTI） 相比，弥散峰度成像 （DKI） 和神经突取向离散和密度成像 （NODDI） 为脑白质 （WM） 的微观结构改变提供了更全面和信息更丰富的视角，尤其是在交叉纤维的检测方面。然而，使用多壳弥散成像对无神经精神症状的系统性红斑狼疮患者（非 NPSLE 患者）的研究仍然很少。共有 49 例非 NPSLE 患者和 41 例年龄、性别和教育程度匹配的健康对照接受了多壳弥散磁共振成像。共评估了 10 个基于 DKI （分数各向异性、平均扩散率、轴向扩散率、径向扩散率、平均峰度、轴向峰度和径向峰度）和 NODDI （各向同性扩散室的取向色散指数和体积分数）的扩散指标。进行基于区域的空间统计 （TBSS） 和基于图谱的感兴趣区域 （ROI） 分析，以确定脑 WM 微观结构的组差异。确定多壳扩散指标与临床指标的关联以供进一步调查。TBSS 分析显示非 NPSLE 患者 WM 的 FA 、 AD 和 RK 降低，ODI 增加 （P < 0.05，家庭误差校正），ODI 表现出最好的判别能力。基于 Atlas 的 ROI 分析发现，非 NPSLE 患者丘脑前放疗 （ATR） 、额枕下束 （IFOF） 、大镊子 （F_major）、小镊子 （F_minor） 和钩状束 （UF） 的 ODI 值增加，右侧 ATR 表现出最好的鉴别能力。F_major 中的 ODI 与 C3 呈正相关。 本研究表明，DKI 和 NODDI 指标可以互补检测非 NPSLE 患者的 WM 异常，并揭示 ODI 是比 DKI 更敏感和特异的生物标志物，指导进一步了解 SLE 中外观正常的 WM 损伤的病理生理机制。