Novel imaging diagnosis of neuropsychiatric systemic lupus erythematosus using topological data analysis: A retrospective study

Introduction: Diagnosing neuropsychiatric systemic lupus erythematosus (NPSLE) and differentiating it from systemic lupus erythematosus (SLE) without neuropsychiatric manifestations remains a substantial clinical challenge due to the absence of specific biomarkers. Topological data analysis (TDA) is a novel computational technique that enables the visualization, exploration, and analysis of complex data structures. This study aimed to identify distinct neuroimaging biomarkers in patients with NPSLE (NPSLE group) and differentiate them from patients with SLE without neuropsychiatric symptoms (non-NPSLE group) by employing TDA. Methods: We conducted a retrospective cohort study involving 30 patients with NPSLE and 30 without neuropsychiatric symptoms between 2005 and 2020. TDA was utilized to extract topological features, specifically connected components and holes, from fluid-attenuated inversion recovery (FLAIR) sequences obtained via brain magnetic resonance imaging (MRI). Summary statistics, including critical point count, persistence lifetime, centroid coordinates, perimeter, area, and filamentarity, were derived from persistence diagrams. Results: Multiple logistic regression analyses, adjusted for age, cerebrovascular comorbidities, and 50% hemolytic unit of complement levels, demonstrated a significant association between NPSLE and the perimeter of the holes (odds ratio [OR]: 1.67, 95% confidence interval [CI]: 1.07–2.63, p = 0.025) and the area of the holes (OR: 4.42, 95% CI: 1.35–19.6, p = 0.026) of the identified topological features. Additionally, both areas under the receiver operating characteristic curve (AUC) exceeded 0.8, indicating good diagnostic accuracy. Conclusion: This study identified novel neuroimaging biomarkers for the diagnosis of NPSLE. The application of TDA to brain MRI features in patients with SLE proved to be a valuable diagnostic tool, particularly through the analysis of persistence diagrams.