Wayne S. Fang MD, Presenter: Nothing to Disclose

Hans Christian Davidson MS, MD, Abstract Co-Author: Consultant, Amirsys, Inc, Salt Lake City, UT Shareholder, Amirsys, Inc, Salt Lake City, UT

Elaine Skalabrin, Abstract Co-Author: Nothing to Disclose

Alan Sawitzke, Abstract Co-Author: Nothing to Disclose

Edward Zamrini, Abstract Co-Author: Nothing to Disclose

Jeffrey S. Anderson MD, PhD, Abstract Co-Author: Nothing to Disclose

Karen Lisa Salzman MD, Abstract Co-Author: Consultant, Amirsys, Inc, Salt Lake City, UT Stockholder, Amirsys, Inc, Salt Lake City, UT

et al, Abstract Co-Author: Nothing to Disclose

Antiphospholipid syndrome (APS) is an autoimmune condition associated with multisystemic manifestations including thrombosis and recurrent miscarriage.  Neurologic symptoms in antiphospholipid syndrome include stroke, dementia, epilepsy and behavioral changes. Pathophysiologic investigations have focused on sequelae of thromboembolic events. Our objective is to assess cortical morphologic changes in APS patients unrelated to thromboembolism.

Twenty-eight patients with APS and MR imaging were gathered retrospectively and compared to age-matched normal controls and to patients with Alzheimer disease (AD). Two blinded neuroradiologists evaluated axial FLAIR or axial T1 images for each study and graded degree of atrophy in the temporal, parietal, frontal, and occipital lobes, discounting focal areas of encephalomalacia due to thromboembolic infarction. In addition, standardized gyral metrics were obtained in the post-central and superior frontal gyri for all patients. Ratios of post-central gyri versus superior frontal gyri were compared among APS, normal controls and Alzheimer patients. 

APS patients showed statistically significant atrophy compared to a normal age-matched control population (p=7 x10-7). Atrophy was particularly striking in the post-central regions for APS patients, out of proportion to that observed in other brain regions (p=0.005). Parietal atrophy scored by neuroradiologists was significantly different in APS patients compared to age-matched controls  (p=0.007), and this finding was corroborated by comparing post-central/superior frontal gyral ratios  among APS patients and normal controls (p=0.03). A subset of APS patients with severe MRI findings showed significantly increased parietal atrophy out of proportion to other lobes compared to that of AD patients.

Focal post-central cortical atrophy is present in APS patients. Imaging findings suggest that the pathophysiology of APS may involve neurodegenerative features not explained by discrete thromboembolic ischemic events.

Charcteristic neurodegenerative features for APS detectable by MRI contributes to specific non-invasive diagnoses for patients with atrophy.

Fang, W, Davidson, H, Skalabrin, E, Sawitzke, A, Zamrini, E, Anderson, J, Salzman, K, et al, , Focal Post-central Atrophy in Antiphospholipid Syndrome.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6015494.html