TZAROUCHI LC 1, TSIFETAKI N 2, KONITSIOTIS S 3, ASTRAKAS LG 4, ZIKOU AK 1, ΒΟTZORIS V 2, DROSOS A 2, ARGYROPOULOU MI 1 Diffusion Tensor Imaging and T 2 Relaxometry in primary Sjogren’s Sundrome 1.DEPARTMENT OF RADIOLOGY 2.DEPERTMENT OF RHEUMATOLOGY 3.DEPARTMENT OF NEUROLOGY 4.DEPARTMENT OF MEDICAL PHYSICS MEDICAL SCHOOL, UNIVERSITY OF IOANNINA, GREECE

INTRODUCTION Sjogren’s Syndrome 2-3 % adult population Autoimmune disorder Glandular, extra-glandular manifestations Central Nervous System involvement ? 1-25%, neurological or psychiatric symptoms 1-25%, neurological or psychiatric symptoms Primary (pSS) Primary (pSS) Secondary Secondary Ann Rheum Dis Jun;63(6):616-20

INTRODUCTION MRI studies T2/FLAIR : white matter hyperintensities (WMHIs) MRI studies T2/FLAIR : white matter hyperintensities (WMHIs) SPECT studies perfusion SPECT studies perfusion Tzarouchi et al (ECR 2009): 52 pSS/35 controls Tzarouchi et al (ECR 2009): 52 pSS/35 controls WMHIs 80.8%/48.6% WMHIs 80.8%/48.6% Voxel-Based Morphometry (VBM) Voxel-Based Morphometry (VBM) Grey matter atrophy White matter atroph White matter atrophy

INTRODUCTION Relaxometry: measurment of transverse T 2 relaxation time Relaxometry: measurment of transverse T 2 relaxation time tissue properties (e.g. water, protein, iron content, tissue properties (e.g. water, protein, iron content, gliosis) gliosis) Diffusion Tensor Imaging: fractional anisotropy index (FA) Diffusion Tensor Imaging: fractional anisotropy index (FA) tissue microstructural changes, tracking white matter fibers tissue microstructural changes, tracking white matter fibers

PURPOSE To assess in pSS: T 2 relaxation time (T 2 ) Fractional anisotropy index (FA) T 2 relaxation time (T 2 ) Fractional anisotropy index (FA) Voxel Based Relaxometry (VBR) Voxel Based Diffusion Tensor Imaging

MATERIALS AND METHODS Ι Study population  32 patients with pSS Aged: 64.56±15.6 years Aged: 64.56±15.6 years Disease Duration: 10.5±5.75 years Disease Duration: 10.5±5.75 years  18 age-matched controls Exclusion criteria: Head trauma, neuropsychiatric disorder, uncontrolled hypertension, diabetes mellitus, blood dyscrasias, metabolic disorders or renal, hepatic or respiratory failure, smoking habits, alcohol intake, migraine

MATERIALS AND METHODS ΙΙ 1.5 Tesla unit, head coil  Multi-slice, spin-echo planar diffusion tensor pulse sequence (TE=131 msec, TR=9807 msec, matrix size=112 x 128, thickness=3 mm, FOV=230 mm, max b-value=700 sec/mm2, 16 non-collinear directions)  Multi-echo, multi-slice T2-weighted (TR=2200 sec, TE= sec, thickness=5 mm, gap=0.5, acquisition matrix=156, reconstruction matrix=256)

Voxel by voxel Student’s t-test Smoothing Normalisation MNI template P < 0.05 FWE correction SPM 5.0 software Voxel-Based Relaxometry data postprocessing T 2 maps

Voxel-Based DTI – data postprocessing Normalization b0 image Smoothing FA map Normalization SPM 5.0 software Voxel by voxel Student’s t-test DTI studio P < 0.05 FWE correction

VBR RESULTS

Voxel-Based DTI results

Does brain atrophy affect T 2 time Biological Parametring Mapping (BPM) Analysis of Covariance (ANCOVA) VBR data: primary modality VBM data: imaging regressors ? T 2 relaxation time DISCUSSION Ι * Neuroimage (2007); 34(1):

VBR results ANCOVA results

DISCUSSION ΙΙ * Rheumatol Int 2003; 23: * J Nuclear Med 1998; 39:8 fractional anisotropy Early white matter damage Small vessel vasculitis Small vessel vasculitisor Degenerative process due to grey matter atrophy Degenerative process due to grey matter atrophy

CONCLUSION In primary Sjogren’s Syndrome: Brain atrophy affects T 2 relaxation time measurments Brain atrophy affects T 2 relaxation time measurments Diffusion tensor imaging detects early white matter lesions Diffusion tensor imaging detects early white matter lesions