OJRad  Vol.5 No.1 , March 2015
The Value and the Variability of Magnetic Resonance Imaging in Patients with Systemic Lupus Erythematosus and Antiphospholipid Syndrome
ABSTRACT
Objectives: The objectives of this article are twofold: To review the value and the variability of MR imaging (MRI) findings in patients with systemic lupus erythematosus (SLE) and to reveal the frequency of central nervous system (CNS) involvement. SLE is a complex multisystem autoimmune connective tissue disorder with a broad spectrum of clinical presentations. Materials and methods: We present three cases, two with neurological symptoms and one case with musculoskeletal symptoms. Patients were imaged in the MRI department of the University Hospital of Patras. All patients had a previous history of antiphospholipid syndrome and known SLE. Results: None of the pts had a normal brain MRI. Abnormal lesions were typically high on FLAIR and T2-weighted images. One patient showed myositis of the tibial muscles bilateral and although she did not reveal any neurological symptoms, because of the presence of APS, she underwent brain MRI to detect any cerebrovascular involvement. The brain MRI was abnormal and showed extensive lesions and porencephalia. In all cases the differential diagnosis of the brain MRI included vasculitis, focal ischemia, multiple sclerosis or other entities. Parenchymal volume loss-cerebral atrophy, incompatible with their age, was obvious in all patients. Conclusion: Magnetic resonance imaging is the gold standard for the investigation of central nervous system in patients suffering from lupus. Lupus patients who also develop antiphospholipid syndrome must be submitted to brain MRI because central nervous involvement is very common and serious, although symptoms may be silent as in our case.

Cite this paper
Solomou, E. , Rigopoulou, A. and Petsas, T. (2015) The Value and the Variability of Magnetic Resonance Imaging in Patients with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Open Journal of Radiology, 5, 28-33. doi: 10.4236/ojrad.2015.51005.
References
[1]   Ruiz-Irastorza, G., Khamashta, M.A. and Castellino, G. (2001) Systemic Lupus Erythematosus. Lancet, 357, 1027-1032.
http://dx.doi.org/10.1016/S0140-6736(00)04239-2

[2]   Welsh, R.C., Rahbar, H., Foerster, B., Thurnher, M. and Sundgren, P.C. (2007) Brain Diffusivity in Patients with Neuropsychiatric Systemic Lupus Erythematosus with New Acute Neurological Symptoms. Journal of Magnetic Resonance Imaging, 26, 541-551.
http://dx.doi.org/10.1002/jmri.21036

[3]   Bertsias, G.K., Ioannidis, J.P. and Aringer, M. (2010) EULAR Recommendations for the Management of Systemic Lupus Erythematosus with Neuropsychiatric Manifestations: Report of a Task Force of the EULAR Standing Committee for Clinical Affairs. Annals of the Rheumatic Diseases, 69, 2074-2082.
http://dx.doi.org/10.1136/ard.2010.130476

[4]   Lalani, T.A., Kanne, J.P. and Hatfield, G.A. (2004) Imaging Findings in Systemic Lupus Erythematosus. Radiographics, 24, 1069-1086.
http://dx.doi.org/10.1148/rg.244985082

[5]   Hawro, T., Bogucki, A., Sysa-Jedrzejowska, A., Bogaczewicz, J. and Wozniacka, A. (2009) Neurological Disorders in Systemic Lupus Erythematosus Patients. Polski Merkuriusz Lekarski, 26, 43-48.

[6]   Greenberg, B.M. (2009) The Neurologic Manifestations of Systemic Lupus Erythematosus. Neurologist, 15, 115-121.
http://dx.doi.org/10.1097/NRL.0b013e31818ff9aa

[7]   Hanly, J.G., Cassell, K. and Kiska, J.D. (1997) Cognitive Function in Systemic Lupus Erythematosus: Results of a Five Year Prospective Study. Arthritis & Rheumatism, 40, 1542-1543.
http://dx.doi.org/10.1002/art.1780400825

[8]   Castellino, G., Padovan, M., Bortoluzzi, A., Borrelli, M., Feggi, L., Caniatti, M.L., Trotta, F. and Govoni, M. (2008) Single Photon Emission Computed Tomography and Magnetic Resonance Imaging Evaluation in SLE Patients with and without Neuropsychiatric Involvement. Rheumatology, 47, 319-323.
http://dx.doi.org/10.1093/rheumatology/kem354

[9]   Arinuma, Y., Kikuchi, H., Wada, T., et al. (2014) Brain MRI in Patients with Diffuse Psychiatric/Neuropsychological Syndromes in Systemic Lupus Erythematosus. Lupus Science & Medicine, 1, Article ID: e000050.

[10]   Hanly, J.G., Urowitz, M.B. and Sanchez-Guerrero, J., et al. (2007) Neuropsychiatric Events at the Time of Diagnosis of Systemic Lupus Erythematosus: An International Inception Cohort Study. Arthritis & Rheumatism, 56, 265-273.
http://dx.doi.org/10.1002/art.22305

[11]   Afeltra, A., Garzia, P., Mitterhofer, A.P., et al. (2003) Neuropsychiatric Lupus Syndromes: Relationship with Antiphospholipid Antibodies. Neurology, 61, 108-110.
http://dx.doi.org/10.1212/01.WNL.0000058904.94330.A7

[12]   Alarcon-Segovia, D., Deleze, M. and Oria, C.V. (1989) Antiphospholipid Antibodies and the Antiphospholipid Syndrome in Systemic Lupus Erythematosus. A Prospective Analysis of 500 Consecutive Patients. Medicine, 68, 353-365.

[13]   Wallace, D.J. (2002) The Musculoskeletal System. In: Wallace, D.J. and Hahn, B.H., Eds., Dubois, Lupus Erythematosus, 6th Edition, Williams and Wilkins, Philadelphia, 629-644.

 
 
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