Analysis of clinical and laboratory features of patients with neuro-behçet's disease

Dissertation Information: Emekli AS, Analysis of Clinic and Laboratory Features of Patients with Neuro-Behçet's Disease. Istanbul University Istanbul Faculty of Medicine, Department of Neurology, Neurology Dissertation, Istanbul, 2020. Introduction and Objective: Behçet's disease (BD) is an inflammatory disorder with multisystemic involvement. Neuro-Behçet's disease (NBD) is the most disabling involvement of BD. In NBD, parenchymal lesions tend to occur in the mesodiencephalic region and brainstem, as reported in large series of NBD. In this study, we aimed to map the probability of parenchymal lesions to present more accurate localization of affected structures within the brain parenchyma and its relationship with the clinical and laboratory features of these patients. Method: We included 66 non-standardized acute MRIs of 55 patients with parenchymal NBD (p-NBD). T2-weighted axial images were used to detect the lesions and digitalized by CAD software. Boundaries of lesions were determined as polygons and converted into high definition raster datasets. Digitalized lesions are transferred into the International Consortium of Brain Mapping 152 brain template. Spatial analyses were performed to sum up intersected boundaries. Lesion probability maps were obtained according to clinical and laboratory subgroups. Subtraction maps were created to exhibit the differences explicitly. Statistically significant anatomical locations were determined. Besides, the clinical and laboratory features of the patients were correlated with the lesion locations. Findings: A total of 66 MRIs of 55 patients were used to generate probability maps. We found that late-onset disease was associated with progressive and severe disease. Higher disability scores in the first attack predicted progressive disease course. Based on the lesion topography, the most frequently affected parenchymal structures were rostral pons, mesencephalon, and diencephalic region. Interestingly, the brainstem was more commonly affected in females (p<0.01). In the late-onset disease, lesions were localized in the corticospinal tracts and caudal brainstem (p<0.01). Progressive disease and severe disability at the end of the follow up period was associated with corticospinal tract lesions during relapses (p<0.01). Patients with positive pathergy test were more likely to be affected in the right hemisphere (p<0.01). Cyclosporin induced lesions tend to be in atypical locations such as hemispheric white matter. Discussion: In the published studies on NBD, lesions were localized according to rough anatomical regions. Our study provides accurate localization of lesions with objective visual maps and structural involvement of NBD subgroups. Besides, our study investigated the relationship of the clinical and laboratory features with lesion locations. This novel technique for lesion probability mapping is simple, fast and does not require any coding.