Systemic lupus erythematosus MRI

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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
Cholecystitis
  • Pericholecystic fluid
  • Gall bladder wall thickening
  • Usually present as acalculus cholecystitis
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
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
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
Neurological Vasculitis
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
Neuropathies
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
Musculoskeletal Raynaud phenomen
Myositis
Arthritis/tenosynovitis
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

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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