Study of MRI brain findings and carotid US features in systemic sclerosis patients, relationship with disease parameters

Background/objectives: Systemic sclerosis (SSc) is an autoimmune disease associated with immune abnormalities and widespread vascular lesions, including increased intimal and medial thickness. These changes may be reflected in early atherosclerosis and cardiovascular risks. We aimed in this study to examine the carotid artery intima-media thickness and MRI brain findings in SSc patients and compared them to a group of normal controls. A relationship between these parameters and clinical measures in SSc was also sought. Methods: Seventy-two SSc patients with no central nervous system (CNS) symptoms and 42 healthy controls were included. Clinical and laboratory measures, Medsger's severity scale, and Doppler ultrasound common carotid artery intima-media thickness (CCA-IMT) were measured. Brain fluid-attenuated inversion recovery (FLAIR)-MRI and diffusion-weighted MRI (DWI) were also done. Results: SSc patients had more CCA-IMT, higher CRP, and more brain MRI hyperintense lesions than controls (P<0.05). Significant positive correlations existed between CCA-IMT and Medsger vascular (r=0.7, P=0.02). The FLAIR-MRI showed multiple hyperintense lesions in 24 patients (33%), ranging 0-36 lesions. SSc patients with more lesions (positive MRI) had longer disease duration (P=0.001) and left and right carotid artery atheromata (P=0.001, and 0.013, respectively) than SSc patients with negative MRIs; Medsger vascular score did not separate the SSc groups (P=0.08). Conclusions: In systemic sclerosis patients without central nervous system symptoms, MRI lesion numbers correlated with CCA-IMT. MRI abnormalities were found more frequently if CRP was elevated, if the Medsger SSc Severity Scale was increased, or if there was thickened carotid IMT.