Systemic lupus erythematosus MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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:

Organ involvement	Disease	MRI	Preview
Gastrointestinal	Hepatitis	Hepatomegaly Nodules that ranging around 0.5-4.5 cm in diameter  T2: nonspecific, increased periportal edema	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 Hypervascular appearance of the mesentery
Cardiac	Mitral stenosis	Mitral leaflet thickening Reduced diastolic opening Abnormal valve motion toward the left ventricular outflow tract
	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 the left and right ventricles	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	General	White matter lesions Periventricular hyperintensities Detects clinically silent lesions	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	Optic neuritis Retrobulbar intra-orbital segment of the optic nerve appears swollen High T2 signal that may persists and be permanent Chronic involvement of optic nerve Atrophied nerve Contrast enhancement of the nerve, best seen with fat-suppressed T1 coronal images	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	Contrast-enhanced MR angiograph Characteristic narrowing of digital vessels Tapering of digital vessels	Adapted from Radiopaedia
	Myositis	Intramuscular edema (increased high T2 signal)	Adapted from Radiopaedia
	Arthritis/tenosynovitis	Capsular swelling Proliferative tenosynovitis Synovial overgrowth	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