Distribution of white matter hyperintensity in systemic sclerosis patients: a monocenter, cross-sectional magnetic resonance imaging study

Shihan Xu; Xinyu Tong; Huilin He; Mengtao Li; Zuoxiang He; Xihai Zhao; Dong Xu

doi:10.1093/rheumatology/keaf343

Distribution of white matter hyperintensity in systemic sclerosis patients: a monocenter, cross-sectional magnetic resonance imaging study

Rheumatology (Oxford). 2025 Jun 23:keaf343. doi: 10.1093/rheumatology/keaf343. Online ahead of print.

Authors

Shihan Xu¹, Xinyu Tong², Huilin He¹, Mengtao Li¹, Zuoxiang He², Xihai Zhao³, Dong Xu¹

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
² Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
³ Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China.

PMID: 40581380
DOI: 10.1093/rheumatology/keaf343

Abstract

Objectives: Systemic Sclerosis (SSc) is a systemic autoimmunity White matter hyperintensities (WMH) are typical indicators of cerebral small vessel disease, classified into periventricular hyperintensity (PVH) and deep white matter hyperintensity(DWMH). Our study aims to investigate the quantitative characteristics and distribution patterns of WMH between SSc patients, healthy population and between different SSc subtypes using Magnetic Resonance(MR) imaging. Whether cognitive dysfunction and anxiety/depression are associated with white matter alterations in the SSc were also explored.

Methods: SSc patients and healthy controls(HCs) were recruited and brain MR was performed. Clinical information, laboratory tests and scales were collected. Whole white matter and WMH volume were segmented and quantified. Independent t test, Mann-Whitney U test and the χ2 test were applied to determine the differences between groups. Clinical information and its association with WMH were investigated by logistic regression.

Results: 84 SSc patients and 30 HCs were included. WMH was more prevalent and a significantly greater proportion of DWMH [2.28*1 0 -4 (IQR 0.35*1 0 -4, 9.68*1 0 -4) vs 0.91*1 0 -4 (IQR 0,3.31*1 0 -4), p= 0.0339] was notified in SSc patients. Distinct WMH distribution patterns were noted between SSc subtypes, that PVH/WMH proportion corrected residual value was larger in dcSSc patients [0.06 (IQR -0.15-0.17) vs -0.16 (IQR -0.30-0.13), p= 0.0346]. No correlations were found between scales results and WMH volume ratios.

Conclusion: These findings suggested that SSc patients are more likely to acquire WMH, particularly in the deep white matter regions. Comparisons also lend support to the hypothesis that the distribution patterns of WMH between dcSSc and lcSSc patients might be distinct.

Keywords: magnetic resonance imaging; systemic sclerosis; white matter hyperintensity.

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