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• Clinical Article •
Assessing glymphatic system dysfunction based on the DTI-ALPS method and choroid plexus remodeling in neuropsychiatric systemic lupus erythematosus: A correlation study
TANG Yanting  YANG Bingxia  ZHANG Ao  ZHAO Lianping  ZHOU Shuhong  ZHANG Wenwen 

DOI:10.12015/issn.1674-8034.2026.07.003.


[Abstract] Objective To investigate the characteristics of glymphatic system dysfunction and choroid plexus (ChP) morphological remodeling in patients with neuropsychiatric systemic lupus erythematosus (NPSLE) using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) and deep learning-based ChP segmentation, and to further explore their correlations with disease activity.Materials and Methods This prospective cross-sectional study included 47 patients with NPSLE and 59 concurrently recruited healthy controls between December 2023 and October 2025. All participants underwent conventional magnetic resonance imaging, high-resolution 3D T1-weighted imaging, and diffusion tensor imaging (DTI). The DTI-ALPS index was calculated to quantitatively evaluate glymphatic clearance. Furthermore, a 3D U-Net model was utilized to automatically segment the ChP of the lateral ventricles and quantify its volume. Partial correlation analyses, adjusting for age, years of education, and total intracranial volume, were performed to assess the associations between these neuroimaging metrics and the SLE Disease Activity Index (SLEDAI) score, Montreal Cognitive Assessment (MoCA) score, and disease duration.Results Compared to healthy controls, patients with NPSLE exhibited significantly reduced left DTI-ALPS indices (F = 6.235, P = 0.014), right DTI-ALPS indices (F = 10.168, P = 0.002) and global mean DTI-ALPS indices (F = 9.764, P = 0.002), and concomitantly increased left normalized ChP volume ratio (F = 9.532, P = 0.003), right normalized ChP volume ratio (F = 9.153, P = 0.003), and total normalized ChP volume ratio (F = 11.208, P = 0.001). Correlation analysis showed that, in the NPSLE group, the mean DTI-ALPS index was negatively correlated with the SLEDAI score (r = -0.436, P = 0.003), whereas there were no significant correlations between the mean DTI-ALPS index and the normalized ChP volume ratio, nor between these two parameters and disease duration or MoCA score (all P > 0.05).Conclusions NPSLE patients exhibit glymphatic dysfunction and ChP morphological remodeling, and DTI-ALPS, which is closely correlated with SLEDAI, may serve as an imaging biomarker for monitoring central nervous system involvement and assessing disease fluctuation.
[Keywords] systemic lupus erythematosus；neuropsychiatric systemic lupus erythematosus；diffusion tensor imaging；magnetic resonance imaging；choroid plexus；glymphatic system；neuroimmunity；disease activity

TANG Yanting1   YANG Bingxia1   ZHANG Ao1   ZHAO Lianping2   ZHOU Shuhong3   ZHANG Wenwen2*  

1 The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou 730000, China

2 Department of Radiology, Gansu provincial Hospital, Lanzhou 730000, China

3 Department of Rheumatology and Immunology, Gansu Provincial Hospital, Lanzhou 730000, China

Corresponding author: ZHANG W W, E-mail: awen1007@126.com

Conflicts of interest   None.

Received  2026-03-25
Accepted  2026-06-09
DOI: 10.12015/issn.1674-8034.2026.07.003
DOI:10.12015/issn.1674-8034.2026.07.003.

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