Systemic lupus erythematosus MRI: Difference between revisions

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__NOTOC__
__NOTOC__
{{Systemic lupus erythematosus}}
{{Systemic lupus erythematosus}}
{{CMG}}
{{CMG}} {{AE}} {{MIR}}


==Overview==
==Overview==
On [[MRI|abdominal MRI]], systemic lupus erythematosus (SLE) may be characterized by [[hepatomegaly]], [[Pancreas|pancreatic]] parenchymal enlargement, and hypervascularity of [[mesentery]]. On [[cardiac MRI]], SLE may be characterized by mitral leaflet thickening, pericardial thickness, and [[Pericardial effusion|pericardial effusions]]. On brain [[MRI]], SLE may be characterized by [[white matter]] [[Lesion|lesions]], changes in [[blood circulation]] of the brain, and patchy areas of enhancement. On musculoskeletal [[MRI]], SLE may be characterized by [[intramuscular]] [[edema]], [[Tenosynovitis|proliferative tenosynovitis]], and [[bone marrow]] [[edema]].


===== Joint and synovial evaluation =====
== Key MRI findings in systemic lupus erythematosus ==
Reveal erosive changes and abnormalities of the soft tissues more often, including:
Most of SLEs complications can be visualized with other, more feasible imaging techniques, so MRI is not the imaging modality of choice for the diagnosis of most complications of SLE. However, if it is done, the following changes can be found in different organ systems of the body:<ref name="pmid23812167">{{cite journal |vauthors=Appenzeller S |title=Magnetic resonance imaging in systemic lupus erythematosus: where do we stand? |journal=Cogn Behav Neurol |volume=26 |issue=2 |pages=53–4 |year=2013 |pmid=23812167 |doi=10.1097/WNN.0b013e31829d5b60 |url=}}</ref><ref name="pmid26309728">{{cite journal |vauthors=Thurman JM, Serkova NJ |title=Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus |journal=F1000Res |volume=4 |issue= |pages=153 |year=2015 |pmid=26309728 |pmc=4536614 |doi=10.12688/f1000research.6587.2 |url=}}</ref><ref name="pmid26038342">{{cite journal |vauthors=Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC |title=Imaging of cardiovascular complications in patients with systemic lupus erythematosus |journal=Lupus |volume=24 |issue=11 |pages=1126–34 |year=2015 |pmid=26038342 |pmc=4567427 |doi=10.1177/0961203315588577 |url=}}</ref><ref name="pmid26236469">{{cite journal |vauthors=Sarbu N, Bargalló N, Cervera R |title=Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus |journal=F1000Res |volume=4 |issue= |pages=162 |year=2015 |pmid=26236469 |pmc=4505788 |doi=10.12688/f1000research.6522.2 |url=}}</ref><ref name="pmid24696368">{{cite journal |vauthors=Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S |title=Chest imaging manifestations in lupus nephritis |journal=Clin. Rheumatol. |volume=33 |issue=6 |pages=817–23 |year=2014 |pmid=24696368 |doi=10.1007/s10067-014-2586-2 |url=}}</ref><ref name="pmid22901453">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=192–202 |year=2013 |pmid=22901453 |doi=10.1016/j.crad.2012.06.109 |url=}}</ref><ref name="pmid23943987">{{cite journal |vauthors=Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y |title=Central nervous system involvement in systemic lupus erythematosus: an imaging challenge |journal=Isr. Med. Assoc. J. |volume=15 |issue=7 |pages=382–6 |year=2013 |pmid=23943987 |doi= |url=}}</ref><ref name="pmid1448334">{{cite journal |vauthors=Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K |title=[Imaging diagnosis of lupus enteritis--especially about sonographic findings] |language=Japanese |journal=Nihon Igaku Hoshasen Gakkai Zasshi |volume=52 |issue=10 |pages=1394–9 |year=1992 |pmid=1448334 |doi= |url=}}</ref><ref name="pmid25275093">{{cite journal |vauthors=Adachi JD, Lau A |title=Systemic lupus erythematosus, osteoporosis, and fractures |journal=J. Rheumatol. |volume=41 |issue=10 |pages=1913–5 |year=2014 |pmid=25275093 |doi=10.3899/jrheum.140919 |url=}}</ref><ref name="pmid21718325">{{cite journal |vauthors=Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M |title=PET/CT imaging in systemic lupus erythematosus |journal=Ann. N. Y. Acad. Sci. |volume=1228 |issue= |pages=71–80 |year=2011 |pmid=21718325 |doi=10.1111/j.1749-6632.2011.06076.x |url=}}</ref><ref name="pmid22901452">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=181–91 |year=2013 |pmid=22901452 |doi=10.1016/j.crad.2012.06.110 |url=}}</ref>
* Capsular swelling
* Proliferative tenosynovitis
* Synovial overgrowth
 
===== Neurological evaluation =====
MRI is more sensitive than CT, and may reveal the following abnormalities:
* Focal neurological defects
* White matter lesions
* Periventricular hyperintensities
* Detects clinically silent lesions
 
===== Cardialogical evaluation =====
* Cine cardiac MR imaging as an noninvasive tool for evaluating
** Abnormal flow patterns
** Ventricular dimensions
** Stroke volume
** Regional myocardial function
 
===== Bone evaluation =====
* Avascular necrosis (AVN)
** Lack of enhancement and devascularized areas on gadolinium-enhanced MR imaging 
** Bone marrow edema on MRI with  
** Low-signal-intensity marginal areas on standard spin-echo T1- and T2-weighted images 
** Intermediate to high signal intensity inside bone tissue on T2-weighted images, producing a line of low signal intensity with an adjacent high-signal-intensity line 
** High signal intensity on T2-weighted images due to subchondral fractures that may be accompanied by fluid signal intensity or edema 
** Low signal intensity on T2-weighted images due to collapse of the articular surface 
 
* Early or subtle insufficiency fractures especially on T2-weighted MR imaging
** In characteristic stress locations insufficiency fractures may appear as areas of high signal intensity due to bone marrow edema
{| class="wikitable"
{| class="wikitable"
!Organ
! style="background: #4479BA; color: #FFFFFF; " |Organ involvement
!Disease
! style="background: #4479BA; color: #FFFFFF; " |Disease
!Description
! style="background: #4479BA; color: #FFFFFF; " |MRI
!CT
! style="background: #4479BA; color: #FFFFFF; " |Preview
!MRI
!SONO
|-
| rowspan="8" |Gastrointestinal system
|[[Dysphagia]]
|
*Barium swallow/esophagography
**Oesophageal stricture
*** Peptic strictures that appear as smooth, tapered narrowing in the distal esophagus
** Esophageal dilatation 
|
|
|
|-
|[[Intestinal pseudo-obstruction]]
|
*dilated bowel loops with or without the presence of fluid levels
*Erect chest radiographs for perforation evaluating
|
* dilated bowel loops with or without the presence of fluid levels
** a distinct transition point where bowel calibre changes from normal to abnormal
** dilated bowel loops proximal to the transition point
*** small bowel >3.5 cm
*** large bowel >5 cm
** collapsed or normal calibre bowel distal to the transitional point
** bowel wall thickening
** Obstruction:
*** pneumoperitoneum indicating perforation
*** bowel ischaemia
|
|
|-
|-
|[[Hepatitis]]
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Gastrointestinal]]</small></small>
![[Hepatitis]]
|
|
**  
* [[Hepatomegaly]]
* [[Nodules]] that ranging around 0.5-4.5 cm in diameter 
** T2: nonspecific, increased periportal [[edema]]
|
|
* Hepatic granulomas
[[File:Webp.net-gifmaker (29).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
* Nonspecific, ranging from normal to hepatomegaly and cirrhosis.


** Discrete, sharply defined nodular lesions within the liver
[[File:Webp.net-gifmaker (30).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|
* nodules ranging around 0.5-4.5 cm in diameter 
** '''T2:''' nonspecific, increased periportal oedema 4
** '''MRCP:''' primary sclerosing cholangitis (PSC) should be excluded
|
|-
|-
|[[Acute pancreatitis]]
![[Cholecystitis]]
|
|
*
* Pericholecystic fluid
|Abnormalities that may be seen in the pancreas include:
* [[Gallbladder|Gall bladder]] wall thickening
* typical findings
*Usually present as acalculus cholecystitis
** focal or diffuse parenchymal enlargement
** changes in density because of oedema
** indistinct pancreatic margins owing to inflammation
** surrounding retroperitoneal fat stranding
* liquefactive necrosis of pancreatic parenchyma
** lack of parenchymal enhancement
** often multifocal
* infected necrosis
** difficult to distinguish from aseptic liquefactive necrosis
** the presence of gas is helpful
** FNA helpful
* abscess formation
** circumscribed fluid collection
** little or no necrotic tissues (thus distinguishing it from infected necrosis)
* haemorrhage
** high-attenuation fluid in the retroperitoneum or peripancreatic tissues
|Contrast-enhanced MR is equivalent to CT in the assessment of pancreatitis.
 
Abnormalities that may be seen in the pancreas include:
* typical findings
** focal or diffuse parenchymal enlargement
** changes in density because of oedema
** indistinct pancreatic margins owing to inflammation
** surrounding retroperitoneal fat stranding
* liquefactive necrosis of pancreatic parenchyma
** lack of parenchymal enhancement
** often multifocal
* infected necrosis
** difficult to distinguish from aseptic liquefactive necrosis
** the presence of gas is helpful
** FNA helpful
* abscess formation
** circumscribed fluid collection
** little or no necrotic tissues (thus distinguishing it from infected necrosis)
* haemorrhage
** high-attenuation fluid in the retroperitoneum or peripancreatic tissues
|
* to identify gallstones as a possible cause
* diagnosis of vascular complications, e.g. thrombosis
* identify areas of necrosis which appear as hypoechoic regions
|-
|Aotpsplenectomy
|If heavily calcified, the splenic remnant may be visible in the left upper quadrant.
|CT easily identifies the abnormally small and irregular splenic remnant, which is usually calcified.
|
|
|Ultrasound will either not be able to demonstrate a spleen at all, or identify a small irregular and shadowing nodule in the splenic bed.
[[File:Webp.net-gifmaker (31).gif|thumb|300px|<SMALL><SMALL>''[https://acgcasereports.gi.org/acalculous-cholecystitis/ Courtesy given to ACG Case Reports]''</SMALL></SMALL>]]
|-
|-
|Enteritis
![[Acute pancreatitis|Pancreatitis]]
|The main feature of enteritis is '''small bowel wall thickening'''. Low density submucosal edema can usually be differentiated from higher density mural haemorrhage or infiltration. Dilatation or strictures may or may not be present, the later if chronic.
|
|
|
* Contrast-enhanced MR is equivalent to CT in the assessment of [[pancreatitis]]
** Abnormalities that may be seen in the pancreas include:
*** Parenchymal enlargement
*** Surrounding [[retroperitoneal]] fat stranding
*** [[Abscess]] formation
**** Circumscribed fluid collection
|
|
[[File:Webp.net-geifmaker.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|[[Mesenteric vascular occlusion|Mesenteric vasculitis]]
![[Mesenteric vascular occlusion|Mesenteric vasculitis]]
|
*
|
* The '''comb sign''' refers to the hypervascular appearance of the mesentery 
* This forms linear densities on the mesenteric side of the affected segments of small bowel, which give the appearance of the teeth of a comb. 
|
|
* The '''comb sign''' refers to the hypervascular appearance of the mesentery 
* Comb sign
* This forms linear densities on the mesenteric side of the affected segments of small bowel, which give the appearance of the teeth of a comb. 
** Hypervascular appearance of the [[mesentery]] 
|
|
|-
|-
|[[Acute cholecystitis]]
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Cardiac]]</small></small>
![[Mitral stenosis]]
|
|
*
* [[Mitral valve sclerosis|Mitral leaflet thickening]]
* Reduced [[diastolic]] opening
* Abnormal valve motion toward the [[Left ventricle|left ventricular]] outflow tract
|
|
* gallbladder distension
* gallbladder wall thickening
* mural or mucosal hyperenhancement
* pericholecystic fluid and inflammatory fat stranding
* enhancement of the adjacent liver parenchyma due to reactive hyperaemia
* tensile gallbladder fundus sign 7
** fundus bulging the anterior abdominal wall
|MR cholangiopancreatography (MRCP) may show an impacted stone in the gallbladder neck or cystic duct as a rounded filling defect.
|
* gallbladder wall thickening (>3 mm) and pericholecystic fluid 
* Positive Murphy sign
* gallbladder distension
*
|-
|-
| rowspan="7" |Pulmonary involvement
![[Pericarditis|Pericarditis]]
|Pleural effusion
|
|
* A lateral decubitus film can visualise small amounts of fluid layering against the dependent parietal pleura.
* The normal [[pericardial]] thickness is considered 2 mm while a thickness of over 4 mm suggests a [[pericarditis]]
* PA and AP CXR:
* Delayed enhancement in the pericardium around heart chambers
** blunting of the costophrenic angle
** blunting of the cardiophrenic angle
** fluid within the horizontal or oblique fissures
** mediastinal shifts with large amounts of fluid
|
|
* May be associated with thickening of the pleura
[[File:Jjjkjgh.jpeg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
* Fluid density
|
|echo-free space between the visceral and parietal pleura
|-
|-
|Respiratory muscle dysfunction
![[Pericardial effusion]]
|elevated hemidiaphragms at chest radiography
 
linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity 
 
Wiedemann HP, Matthay RA. ''Pulmonary manifestations of collagen vascular diseases.Clin Chest Med'' 1989; 10:677-696
|
|
|
* Fluid [[density]] material surrounding the heart
|
|
|-
|-
|[[Pneumonitis|Acute pneumonitis]]
![[Myocarditis]]
|
*A rare and fulminant form of diffuse lung injury that generally occurs in previously healthy individuals and has a rapid onset with [[fever]], [[cough]], and [[Dyspnea|shortness of breath]].
|
|
|
* Regional or global wall motion abnormalities
* [[Pericardial effusion]]
** Early postcontrast enhancement due to regional vasodilatation and increased blood volume, secondary to the [[inflammation]]
|
|
[[File:Lymphocytic-myocarditis.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|[[Pulmonary hemorrhage]]
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Neurological ]]</small></small>
|
!Vasculitis
*Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
**
|
|
|
* [[White matter]] [[lesions]]
* [[Periventricular nucleus|Periventricular]] hyperintensities
* Detects clinically silent [[Lesion|lesions]]
|
|
[[File:675765765.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|[[Pulmonary hypertension]]
![[Stroke]]
|
*Elevated cardiac apex due to right ventricular hypertrophy
* enlarged right atrium
* prominent pulmonary outflow tract
* enlarged pulmonary arteries
* pruning of peripheral pulmonary vessels
|
|
|
* Changes in brain [[Vessels|vessel]] blood flow (occlusion on [[Magnetic resonance angiography|MRA]])  
* No parenchymal changes 
* Slow or stagnant flow in vessels as a loss of normal flow void 
* High T2 signal after 6 hours of [[stroke]]
|
|
[[File:Webp.net-kkkkgifmaker (1).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Pulmonary emboli
![[Neuropathies]]
|
** Fleishner sign: enlarged pulmonary artery (20%)
** Hampton hump: peripheral wedge of airspace opacity and implies lung infarction (20%)
** Westermark sign: regional oligaemia and highest positive predictive value (10%)
** pleural effusion (35%)
** knuckle sign 11
** Palla's sign17: enlarged right descending pulmonary artery
|
* filling defects within the pulmonary vasculature with acute pulmonary emboli
* vascular CT signs include
** direct pulmonary artery signs
*** complete obstruction
*** partial obstruction
*** eccentric thrombus
*** calcified thrombus - calcific pulmonary emboli
*** pulmonary arterial bands/pulmonary arterial webs 1,4-5
*** post stenotic dilatation
** signs related to pulmonary hypertension
*** enlargement of main pulmonary arteries
*** the peripheral pulmonary arteries in affected segments may be narrowed ref required
*** pulmonary arterial calcification
*** tortuous pulmonary vessels
*** right ventricular enlargement/hypertrophy
** signs of systemic collateral supply
*** enlargement of bronchial and nonbronchial systemic arteries
* Signs of chronic obstruction: webs or bands, intimal irregularities 3/ abrupt narrowing or complete obstruction of the pulmonary arteries 3 / “pouching defects” which are defined as chronic thromboembolism organised in a concave shape that “points” toward the vessel lumen
*
* parenchymal signs (often non-specific on their own):
** scars
** mosaic perfusion pattern
** focal ground-glass opacities
** bronchial anomalies
* The central filling defect from the thrombus is surrounded by a thin rim of contrast, appearing like the popular sweet, the polo mint 
|
|
* [[Optic neuritis]]
** [[Retrobulbar block|Retrobulbar]] intra-orbital segment of the [[optic nerve]] appears swollen
*** High T2 signal that may persists and be permanent
** Chronic involvement of [[optic nerve]]
*** [[Atrophy|Atrophied]] nerve
*** Contrast enhancement of the [[nerve]], best seen with fat-suppressed T1 coronal images
|
|
[[File:Hkjhkjhkjhkj.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
[[File:Webp.net-gjjjifmaker (2).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Shrinking lung syndrome
![[Encephalitis|Autoimmune encephalitis]]
|
*small but clear lungs with diaphragmatic elevation
*basal atelectasis 
|
* reduced lung volumes with diaphragmatic elevation +/- occasional basal atelectasis but without any major parenchymal lung or pleural disease 
|
|
* Mostly in [[temporal lobe]]<nowiki/>s and [[Limbic system|limbic systems]]
* Bilateral involvement is most common (60%), although often asymmetric
* [[Cortical area|Cortical]] thickening
* Increased T2/FLAIR signal intensity of affected regions
* Patchy areas of enhancement
|
|
[[File:Webp.net-glkjlifmaker (3).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
| rowspan="7" |Cardiac involvement
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Musculoskeletal]]</small></small>
|[[Cardiomegaly]]
![[Raynaud phenomenon|Raynaud phenomen]]
|
**Cardiac enlargement
|
|
|
* Contrast-enhanced [[MR angiography|MR angiograph]]
** Characteristic narrowing of digital [[vessels]]
** Tapering of digital [[vessels]]
|
|
[[File:Webp.net-gifkjhkumaker (4).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Mitral stenosis
![[Myositis]]
|
|
** cardiomegaly
* [[Edema|Intramuscular edema]] (increased high T2 signal)
** double right heart border (enlarged left atrium and normal right atrium)
* May show an ill-defined, [[hyperintense]], intramuscular lesion, containing isointense lines
** prominent left atrial appendage
** splaying of the subcarinal angle (>120 degrees)
|valve thickening or leaflet fixation
|
* mitral leaflet thickening
* reduced diastolic opening
* abnormal valve motion toward the left ventricular outflow tract
|
|
[[File:Webp.net-gifegtrsmaker (5).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Mitral regurgitation
![[Arthritis]]/[[tenosynovitis]]
|frontal projection
* left atrial enlargement
** convexity or straightening of the left atrial appendage just below the main pulmonary artery (along left heart border)
** double density sign: the right side of the enlarged left atrium pushes into the adjacent lung and creates an addition contour superimposed over the right heart
** elevation of the left main bronchus and splaying of the carina
* upper zone venous enlargement due to pulmonary venous hypertension
* left ventricular enlargement is also eventually present due to volume overload
|
|
|
* Capsular swelling
* [[Tenosynovitis|Proliferative tenosynovitis]]
* [[Synovial]] overgrowth
|
|
[[File:Webp.net-gjhfdifmaker (6).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Acute pericarditis
![[Osteonecrosis]] ([[Avascular necrosis]])
|
*
|enhancement of the thickened pericardium generally indicates inflammation 
|The normal pericardial thickness is considered 2 mm while a thickness of over 4 mm suggests a pericarditis 
|
|-
|Pericardial effuson
|
* globular enlargement of the cardiac shadow giving a water bottle configuration
* Lateral CXR may show a vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly from a similar lucent vertical lucent line (pericardial fat) posteriorly; this is known as the Oreo cookie sign
*
|Fluid density material is seen surrounding the heart
|Fluid density material is seen surrounding the heart
|Echocardiography is the method of choice to confirm the diagnosis, estimate the volume of fluid and most importantly assess the haemodynamic impact of the effusion
|-
|[[Myocarditis]]
|
*
|
|
* regional or global wall motion abnormalities are common, but nonspecific (biventricular wall motion abnormality, however, is the main predictor of death or transplantation)
* pericardial effusion is reported in ~45% (range 32-57%) of patients with myocarditis
** regional vasodilatation and increased blood volume due to the inflammation in myocarditis causes early postcontrast enhancement
|
|-
|[[Coronary heart disease|Coronary artery disease]]
|
*
|
* coronary CT angiography (cCTA)
* can show the amount of stenosis
|
|
|-
| rowspan="3" |Neurological involvement
|[[Cognitive-shifting|Cognitive dysfunction]]
|
*The mental status of SLE patients can be temporarily affected by multiple, transient metabolic and systemic processes
|
|
|
|-
|[[Stroke]]
|
*
|
* Early sign: a hyperdense segment of a vessel, representing direct visualisation of the intravascular thrombus / embolus and as such is visible immediately
* Early hyperacute: loss of grey-white matter differentiation, and hypoattenuation of deep nuclei
* cortical hypodensity with associated parenchymal swelling with resultant gyral effacement
* elevation of the attenuation of the cortex. This is known as the CT fogging phenomenon
* a region of low density with negative mass effect. Cortical mineralisation can also sometimes be seen appearing hyperdense.
*
|
* the affected parenchyma appears normal on other sequences, although changes in flow will be detected (occlusion on MRA) and the thromboembolism may be detected (e.g. on SWI). Slow or stagnant flow in vessels may also be detected as a loss of normal flow void and high signal 
* after 6 hours, high T2 signal will be detected
|
|-
|[[Neuropathies]]
|
*
|
|
* Optic neuritis:
** Typically findings are most easily identified in the retrobulbar intra-orbital segment of the optic nerve, which appears swollen, with high T2 signal. High T2 signal persists and may be permanent; chronically the nerve will appear atrophied rather than swollen.  Contrast enhancement of the nerve, best seen with fat-suppressed T1 coronal images, is seen in >90% of patients if scanned within 20 days of visual loss
|
|-
|
|Autoimmune encephalitis
|
|
|mesial temporal lobes and limbic systems, typically manifested by cortical thickening and increased T2/FLAIR signal intensity of these regions. Bilateral involvement is most common (60%), although often asymmetric
Patchy areas of enhancement
|
|-
|
|Raynaud phenomen
|
|
|contrast-enhanced MR angiography may also reveal characteristic narrowing and tapering of digital vessels 
|Doppler sonography:
flow volume and vessel size irregularities 
|-
|
|Myositis
|
|
|'''Intramuscular oedema''' (increased high T2/STIR signal)
|
|-
| rowspan="4" |Musculoskeletal involvement
|[[Arthritis]]
|
*Mostly symmetrical and non-erosive
*Arthralgias
*Effusions
*Decreased range of motion of both small and large joints
*Morning stiffness
|
|
|
|-
|[[Osteonecrosis]] ([[Avascular necrosis]])
|
*Most common in the femoral head
*Can involve humeral head, tibial plateau, and scaphoid navicular
*Usually bilateral and is often asymptomatic
*Glucocorticoids treatment is associated with the greatest risk of developing the disease
|
|
|
|-
|Subcutaneous nodules
|
*In association with active disease
|
|
|
|-
|Osteoporosis
|
*Mostly due to [[glucocorticoid]] usage
*Loss of height
*Sudden back pain
|
|
|
* Lack of enhancement and devascularized areas on gadolinium-enhanced MR imaging 
* [[Bone marrow]] [[edema]] on MRI 
* Low-signal-intensity marginal areas on standard spin-echo T1- and T2-weighted images 
* Intermediate to high signal intensity inside bone tissue on T2-weighted images, producing a line of low signal intensity with an adjacent high-signal-intensity line 
* High signal intensity on T2-weighted images due to subchondral fractures that may be accompanied by fluid signal intensity or [[edema]] 
* Low signal intensity on T2-weighted images due to collapse of the [[articular surface]] 
* Early or subtle insufficiency fractures especially on T2-weighted MR imaging
** In characteristic stress locations insufficiency fractures may appear as areas of high signal intensity due to [[bone marrow]] edema
|
|
[[File:Webp.net-gifmjyfssaker (7).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
[[File:Webp.net-gifmakk2er (8).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|}
|}
==Examples of MRI Findings in Systemic Lupus Erythematosus==


==References==
==References==

Latest revision as of 16:21, 1 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

On abdominal MRI, systemic lupus erythematosus (SLE) may be characterized by hepatomegaly, pancreatic parenchymal enlargement, and hypervascularity of mesentery. On cardiac MRI, SLE may be characterized by mitral leaflet thickening, pericardial thickness, and pericardial effusions. On brain MRI, SLE may be characterized by white matter lesions, changes in blood circulation of the brain, and patchy areas of enhancement. On musculoskeletal MRI, SLE may be characterized by intramuscular edema, proliferative tenosynovitis, and bone marrow edema.

Key MRI findings in systemic lupus erythematosus

Most of SLEs complications can be visualized with other, more feasible imaging techniques, so MRI is not the imaging modality of choice for the diagnosis of most complications of SLE. However, if it is done, the following changes can be found in different organ systems of the body:[1][2][3][4][5][6][7][8][9][10][11]

Organ involvement Disease MRI Preview
Gastrointestinal Hepatitis
Adapted from Radiopaedia
Adapted from Radiopaedia
Cholecystitis
  • Pericholecystic fluid
  • Gall bladder wall thickening
  • Usually present as acalculus cholecystitis
Courtesy given to ACG Case Reports
Pancreatitis
  • Contrast-enhanced MR is equivalent to CT in the assessment of pancreatitis
    • Abnormalities that may be seen in the pancreas include:
      • Parenchymal enlargement
      • Surrounding retroperitoneal fat stranding
      • Abscess formation
        • Circumscribed fluid collection
Adapted from Radiopaedia
Mesenteric vasculitis
  • Comb sign
Cardiac Mitral stenosis
Pericarditis
  • The normal pericardial thickness is considered 2 mm while a thickness of over 4 mm suggests a pericarditis
  • Delayed enhancement in the pericardium around heart chambers
Adapted from Radiopaedia
Pericardial effusion
  • Fluid density material surrounding the heart
Myocarditis
  • Regional or global wall motion abnormalities
  • Pericardial effusion
    • Early postcontrast enhancement due to regional vasodilatation and increased blood volume, secondary to the inflammation
Adapted from Radiopaedia
Neurological Vasculitis
Adapted from Radiopaedia
Stroke
  • Changes in brain vessel blood flow (occlusion on MRA)  
  • No parenchymal changes 
  • Slow or stagnant flow in vessels as a loss of normal flow void 
  • High T2 signal after 6 hours of stroke
Adapted from Radiopaedia
Neuropathies
Adapted from Radiopaedia
Adapted from Radiopaedia
Autoimmune encephalitis
  • Mostly in temporal lobes and limbic systems
  • Bilateral involvement is most common (60%), although often asymmetric
  • Cortical thickening
  • Increased T2/FLAIR signal intensity of affected regions
  • Patchy areas of enhancement
Adapted from Radiopaedia
Musculoskeletal Raynaud phenomen
Adapted from Radiopaedia
Myositis
Adapted from Radiopaedia
Arthritis/tenosynovitis
Adapted from Radiopaedia
Osteonecrosis (Avascular necrosis)
  • Lack of enhancement and devascularized areas on gadolinium-enhanced MR imaging 
  • Bone marrow edema on MRI 
  • Low-signal-intensity marginal areas on standard spin-echo T1- and T2-weighted images 
  • Intermediate to high signal intensity inside bone tissue on T2-weighted images, producing a line of low signal intensity with an adjacent high-signal-intensity line 
  • High signal intensity on T2-weighted images due to subchondral fractures that may be accompanied by fluid signal intensity or edema 
  • Low signal intensity on T2-weighted images due to collapse of the articular surface 
  • Early or subtle insufficiency fractures especially on T2-weighted MR imaging
    • In characteristic stress locations insufficiency fractures may appear as areas of high signal intensity due to bone marrow edema
Adapted from Radiopaedia
Adapted from Radiopaedia

References

  1. ↑ Appenzeller S (2013). "Magnetic resonance imaging in systemic lupus erythematosus: where do we stand?". Cogn Behav Neurol. 26 (2): 53–4. doi:10.1097/WNN.0b013e31829d5b60. PMID 23812167.
  2. ↑ Thurman JM, Serkova NJ (2015). "Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus". F1000Res. 4: 153. doi:10.12688/f1000research.6587.2. PMC 4536614. PMID 26309728.
  3. ↑ Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC (2015). "Imaging of cardiovascular complications in patients with systemic lupus erythematosus". Lupus. 24 (11): 1126–34. doi:10.1177/0961203315588577. PMC 4567427. PMID 26038342.
  4. ↑ Sarbu N, Bargalló N, Cervera R (2015). "Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus". F1000Res. 4: 162. doi:10.12688/f1000research.6522.2. PMC 4505788. PMID 26236469.
  5. ↑ Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S (2014). "Chest imaging manifestations in lupus nephritis". Clin. Rheumatol. 33 (6): 817–23. doi:10.1007/s10067-014-2586-2. PMID 24696368.
  6. ↑ Goh YP, Naidoo P, Ngian GS (2013). "Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations". Clin Radiol. 68 (2): 192–202. doi:10.1016/j.crad.2012.06.109. PMID 22901453.
  7. ↑ Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y (2013). "Central nervous system involvement in systemic lupus erythematosus: an imaging challenge". Isr. Med. Assoc. J. 15 (7): 382–6. PMID 23943987.
  8. ↑ Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K (1992). "[Imaging diagnosis of lupus enteritis--especially about sonographic findings]". Nihon Igaku Hoshasen Gakkai Zasshi (in Japanese). 52 (10): 1394–9. PMID 1448334.
  9. ↑ Adachi JD, Lau A (2014). "Systemic lupus erythematosus, osteoporosis, and fractures". J. Rheumatol. 41 (10): 1913–5. doi:10.3899/jrheum.140919. PMID 25275093.
  10. ↑ Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M (2011). "PET/CT imaging in systemic lupus erythematosus". Ann. N. Y. Acad. Sci. 1228: 71–80. doi:10.1111/j.1749-6632.2011.06076.x. PMID 21718325.
  11. ↑ Goh YP, Naidoo P, Ngian GS (2013). "Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations". Clin Radiol. 68 (2): 181–91. doi:10.1016/j.crad.2012.06.110. PMID 22901452.

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