How is CNS lupus distinguished from multiple sclerosis and other vasculitides on MRI?

Updated: May 04, 2021
  • Author: Pradeep C Bollu, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

A frequent clinical problem occurs when the MRI reveals multiple, small T2 signal intensities in the white matter, making it difficult to distinguish between multiple sclerosis and SLE or other vasculitides. Although many clinical and laboratory factors assist in this differential diagnosis, the MRI appearance is more supportive of SLE when the lesions are not confined to periventricular white matter but favor the gray-white junction or even involve gray matter of cortex or deep nuclei when the lesions are rounded or patchy in shape. If the lesions are radially oriented along white matter tracts, favor the periventricular white matter, and involve the corpus callosum, then multiple sclerosis is a more likely diagnosis. Using the Fazekas criteria, at least 3 areas of increased signals, and 2 of the following features—lesion abutting body of lateral ventricles, infratentorial lesion location, and lesions larger than 5 mm—led to a further highly significant improvementofspecificity(96%)onproton-density and T2-weighted MRIs of the brain. [31]

Perisulcal cortical atrophy is reported as a frequent finding on CT scans. [32] CT scanning may also detect calcifications in patients with long-standing cerebritis.


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