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Structural MRI scans were acquired and processed using surface-based morphometry (SBM) to extract cortical thickness (CT), gyrification index (GI), fractal dimension (FD) and sulcal depth (SD) within predefined regions of interest. Two-way analysis of variance assessed main effects and \u2018sex\u00d7diagnosis\u2019 interactions (Holm-Bonferroni corrected). Correlation analyses were performed between these structural metrics and SLE disease activity\/psychological assessment scores in areas showing significant interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      196 individuals participated in this study: 30 male SLE patients, 66 female SLE patients, 33 male healthy controls (HC) and 67 female HC. Significant sex-by-disease interactions were detected: SD in left orbital (H-shaped) sulci (S_orbital-H_Shaped) (\n                      <jats:italic>F<\/jats:italic>\n                      =14.8458, p=0.0150), with male HC &gt;male\u2009SLE (p=0.0039) and male HC&gt;female\u2009HC (p&lt;0.0001), and GI in left middle frontal sulcus (S_front_middle) (\n                      <jats:italic>F<\/jats:italic>\n                      =14.1650, p=0.0313), with female SLE&gt;male\u2009SLE (p&lt;0.0001) and male HC&gt;male\u2009SLE (p=0.0003). Diagnostic main effects (HC&gt;SLE) were observed extensively for CT across both hemispheres. No significant correlations emerged between disease activity\/psychological assessment scores and structural parameters in interaction-significant regions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides novel evidence for sex-by-diagnosis interactive effects in the neuropathological mechanisms of SLE. Sex and SLE disease status have both independent and interacting impacts on cerebral cortical structure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT00703742\">NCT00703742<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/lupus-2026-002032","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T14:10:11Z","timestamp":1782396611000},"page":"e002032","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Influence of sex and systemic lupus erythematosus disease status on cerebral cortex 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