Francesco Macri MD, Abstract Co-Author: Nothing to Disclose

Fabricio Pereira PhD, DSc, Abstract Co-Author: Nothing to Disclose

Jean-Christophe Gris MD, PhD, Abstract Co-Author: Nothing to Disclose

Jean-Paul Beregi MD, Abstract Co-Author: Nothing to Disclose

Marcel Parolin Jackowski PhD, Abstract Co-Author: Nothing to Disclose

Choukri Mekkaoui PhD, Presenter: Nothing to Disclose

The impact of antiphospholipid antibodies (aPLAbs) on the brain of neurologically asymptomatic APS women with obstetric manifestations remains controversial [1]. Diffusion tensor imaging (DTI) was used to evaluate the structural integrity of white matter (WM) in women with non-thrombotic pregnancy loss and normal neuropsychiatric history, relative to the presence (APS+) / absence (APS-) of antiphospholipid antibodies (aPL). In addition, diffusion-based indices were compared to the presence/absence of lupus anticoagulant (LA) or aβ2GP1-G antibodies to characterize the level of microstructural alterations.

A total of 83 women with no record of neuropsychiatric symptoms (17 APS- and 66 APS+ women) were imaged using a 3T MRI scanner (GE Healthcare) with standard T1, FLAIR and TOF sequences and DTI (TR/TE=13000/88ms, 32 directions, b=1000s/mmˆ2 and resolution 2×2×2mmˆ3). Patients were tested for LA and/or aβ2GP1-G antibodies (37 APS- and 29 APS+ women). The fractional anisotropy (FA), mean diffusivity (MD) and radial diffusivity (RD) were calculated from DTI. Intergroup comparison of FA, MD and RD was carried out using Tract-Based Spatial Statistics. Regions with significant differences were identified by threshold-free cluster enhancement.

No evidence of WM abnormalities was detected using T1, FLAIR and TOF. However, APS+ patients revealed a significant decrease in FA associated with an increase in MD and RD (p<0.05) compared to APS-. These findings were diffused throughout the brain. In the presence of aPL type LA and/or aβ2GP1-G, these differences were amplified while 6 intracerebral locations were identified statistically (p<0.01).

DTI revealed diffused microstructural WM changes in APS women with early non-thrombotic pregnancy loss, compatible with alterations in the axonal structure and myelin sheath. Compared to standard T1, FLAIR and TOF, DTI appears to be more sensitive to subtle WM abnormalities. REFERENCES 1. Gris JC et al. Comparative incidence of a first thrombotic event in purely obstetric antiphospholipid syndrome with pregnancy loss: the NOH-APS observational study. Blood. 2012

DTI-based indices combined with biological markers determine the level of microstructural WM integrity, leading to improved diagnosis and treatment of asymptomatic APS patients.

Macri, F, Pereira, F, Gris, J, Beregi, J, Jackowski, M, Mekkaoui, C, Diffusion Tensor Imaging in Patients with Obstetric Antiphospholipid Syndrome without Neuropsychiatric Symptoms.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014020.html