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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>
*
 
===== Neurological evaluation =====
MRI is more sensitive than CT, and may reveal the following abnormalities:
*
 
===== 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
!MRI
! style="background: #4479BA; color: #FFFFFF; " |MRI
!SONO
! style="background: #4479BA; color: #FFFFFF; " |Preview
|-
|-
| rowspan="4" |Gastrointestinal system
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Gastrointestinal]]</small></small>
|[[Hepatitis]]
![[Hepatitis]]
|
|
* nodules ranging around 0.5-4.5 cm in diameter 
* [[Hepatomegaly]]
** '''T2:''' nonspecific, increased periportal oedema 4
* [[Nodules]] that ranging around 0.5-4.5 cm in diameter 
** '''MRCP:''' primary sclerosing cholangitis (PSC) should be excluded
** T2: nonspecific, increased periportal [[edema]]
|
|
|-
[[File:Webp.net-gifmaker (29).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]  
|[[Acute pancreatitis]]
|Contrast-enhanced MR is equivalent to CT in the assessment of pancreatitis.


Abnormalities that may be seen in the pancreas include:
[[File:Webp.net-gifmaker (30).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
* 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
|-
|-
|[[Mesenteric vascular occlusion|Mesenteric vasculitis]]
![[Cholecystitis]]
|
|
* The '''comb sign''' refers to the hypervascular appearance of the mesentery 
* Pericholecystic fluid
* 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. 
* [[Gallbladder|Gall bladder]] wall thickening
*Usually present as acalculus cholecystitis
|
|
[[File:Webp.net-gifmaker (31).gif|thumb|300px|<SMALL><SMALL>''[https://acgcasereports.gi.org/acalculous-cholecystitis/ Courtesy given to ACG Case Reports]''</SMALL></SMALL>]]
|-
|-
|[[Acute cholecystitis]]
![[Acute pancreatitis|Pancreatitis]]
|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 
* Contrast-enhanced MR is equivalent to CT in the assessment of [[pancreatitis]]
* Positive Murphy sign
** Abnormalities that may be seen in the pancreas include:
* gallbladder distension
*** 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>]]
|-
|-
| rowspan="5" |Cardiac involvement
![[Mesenteric vascular occlusion|Mesenteric vasculitis]]
|Mitral stenosis
|
|
* mitral leaflet thickening
* Comb sign
* reduced diastolic opening
** Hypervascular appearance of the [[mesentery]] 
* abnormal valve motion toward the left ventricular outflow tract
|
|
|-
|-
|Mitral regurgitation
| 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
|
|
|-
|-
|Acute pericarditis
![[Pericarditis|Pericarditis]]
|The normal pericardial thickness is considered 2 mm while a thickness of over 4 mm suggests a 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
|
[[File:Jjjkjgh.jpeg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Pericardial effuson
![[Pericardial effusion]]
|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)
* Fluid [[density]] material surrounding the heart
* 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
|
|
|-
|-
![[Myocarditis]]
|
|
|General
* Regional or global wall motion abnormalities
|
* [[Pericardial effusion]]
* Focal neurological defects
** Early postcontrast enhancement due to regional vasodilatation and increased blood volume, secondary to the [[inflammation]]
* White matter lesions
* Periventricular hyperintensities
* Detects clinically silent lesions
|
|
[[File:Lymphocytic-myocarditis.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
| rowspan="2" |Neurological involvement
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Neurological ]]</small></small>
|[[Stroke]]
!Vasculitis
|
|
* 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 
* [[White matter]] [[lesions]]
* after 6 hours, high T2 signal will be detected
* [[Periventricular nucleus|Periventricular]] hyperintensities
* Detects clinically silent [[Lesion|lesions]]
|
|
[[File:675765765.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|[[Neuropathies]]
![[Stroke]]
|
|
* Optic neuritis:
* Changes in brain [[Vessels|vessel]] blood flow (occlusion on [[Magnetic resonance angiography|MRA]])  
** 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
* 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>]]
|-
|-
![[Neuropathies]]
|
|
|Autoimmune encephalitis
* [[Optic neuritis]]
|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
** [[Retrobulbar block|Retrobulbar]] intra-orbital segment of the [[optic nerve]] appears swollen
Patchy areas of enhancement
*** 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>]]
|-
|-
![[Encephalitis|Autoimmune encephalitis]]
|
|
|Raynaud phenomen
* Mostly in [[temporal lobe]]<nowiki/>s and [[Limbic system|limbic systems]]
|contrast-enhanced MR angiography may also reveal characteristic narrowing and tapering of digital vessels 
* Bilateral involvement is most common (60%), although often asymmetric
|Doppler sonography:
* [[Cortical area|Cortical]] thickening
flow volume and vessel size irregularities 
* Increased T2/FLAIR signal intensity of affected regions
|-
* Patchy areas of enhancement
|
|Myositis
|'''Intramuscular oedema''' (increased high T2/STIR signal)
|
|
[[File:Webp.net-glkjlifmaker (3).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
| rowspan="4" |Musculoskeletal involvement
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Musculoskeletal]]</small></small>
|[[Arthritis]]
![[Raynaud phenomenon|Raynaud phenomen]]
|
|
* Capsular swelling
* Contrast-enhanced [[MR angiography|MR angiograph]]
* Proliferative tenosynovitis
** Characteristic narrowing of digital [[vessels]]
* Synovial overgrowth
** Tapering of digital [[vessels]]
|
|
[[File:Webp.net-gifkjhkumaker (4).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|[[Osteonecrosis]] ([[Avascular necrosis]])
![[Myositis]]
|
|
* [[Edema|Intramuscular edema]] (increased high T2 signal)
* May show an ill-defined, [[hyperintense]], intramuscular lesion, containing isointense lines
|
|
[[File:Webp.net-gifegtrsmaker (5).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Subcutaneous nodules
![[Arthritis]]/[[tenosynovitis]]
|
|
* 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>]]
|-
|-
|Osteoporosis
![[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
|
|
[[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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