Magnetic resonance imaging in the evaluation of central nervous system manifestations in systemic lupus erythematosus

Central nervous system (CNS) manifestations are often observed in systemic lupus erythematosus (SLE) patients during the course of their disease. The prevalence of CNS manifestations ranges between 17 and 75%, reflecting different methods of patient selection and assessment, varying levels of assessor expertise, and lack of a consensus for diagnosing active and chronic neuropsychiatric (NP) manifestations. Postulated pathogenic mechanisms of peripheral and CNS events include vasculopathy, autoantibody effects, and systemic inflammation. Diagnosis is often difficult because of the lack of standardized diagnostic techniques. Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of CNS manifestations in SLE patients in clinical practice. MRI findings are diverse, and atrophy and hyperintense white matter lesions often correlate poorly with clinical manifestations, occurring also in patients without marked CNS signs and symptoms. We will describe MRI findings in SLE patients and discuss the usefulness of different MRI techniques in evaluating acute and chronic CNS manifestations.