Systemic lupus erythematosus MRI

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

Overview

Joint and synovial evaluation

Reveal erosive changes and abnormalities of the soft tissues more often, including:

• 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

Organ	Disease	MRI	SONO
Gastrointestinal system	Hepatitis	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	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
	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.
	Acute cholecystitis	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
Cardiac involvement	Mitral stenosis	mitral leaflet thickening reduced diastolic opening abnormal valve motion toward the left ventricular outflow tract
	Mitral regurgitation
	Acute pericarditis	The normal pericardial thickness is considered 2 mm while a thickness of over 4 mm suggests a pericarditis
	Pericardial effuson	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
Neurological involvement	Stroke	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)
Musculoskeletal involvement	Arthritis
	Osteonecrosis (Avascular necrosis)
	Subcutaneous nodules
	Osteoporosis