Transcript 18.Module B_Pathology Correlation for CT

RAD 266 Pathology Correlation for CT/MRI
Autoimmune Disease
Module B
Topics Included in Module B
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Immune system responses and disorders
Congenital and acquired Immunodeficiency
Acquired Immunodeficiency
Treatment of Immunodeficiency
Immunodeficiency complications
Autoimmune Disorder
Types of Autoimmune disorders
Types of effects caused from autoimmune
disorder
Treatment of autoimmune disorder
Acquired immunodeficiency syndrome
Systemic lupus erythematosus
Student Objectives
1. Name the common pathological
conditions
affecting the
autoimmune system.
2. For each common pathological
condition identified:
a.describe the disorder
b.list the etiology
c.name the associated symptoms
d.name the common means of diagnosis
e.list characteristic CT and MR manifestations of the
pathology
Continue…
Student Objectives
3.
Identify common pathology on CT
and MRI images.
4.
Identify pathology common only in
pediatric patients.
5. Describe the MR tissue
characteristics of pathologic
processes.
Continue…
Student Objectives
6.
Identify how field strength affects
the ability to visualize select
pathology.
7.
Recognize various differences in
pathologic conditions between
children and adults.
Student Learning activities
1. Read Chapter One, pages 1 – 36.
Pathophysiology, Gutierrez and Peterson
2. Name the immune system cell types,
page 2, Pathophysiology, Gutierrez and
Peterson
3. Review and answer all “Do You
UNDERSTAND” questions in Chapter one,
Pathophysiology, Gutierrez and Peterson
pages 5, 8, 11, 13, 19, 20, 22, 25, 29,
30, 33, 35 and 36.
Continue…..
Student Learning activities
4. Read the following pages, CT and MRI
Pathology A Pocket Atlas, Gray and
Ailinani
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Pages
Pages
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Pages
Pages
Pages
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42, 43 Brain Abscess
46, 47 Multiple Sclerosis (Brain)
72, 73 Multiple Sclerosis (Spinal cord)
86, 87 Vertebral Osteomyelitis
116, 117 Sinusitis
152, 153 Hepatoma
202, 203 Splenomegaly
Continue…..
Student Learning activities
5.Review Pathology Terms and Appendix A
Immune System
The human body has three main types of
defenses against injury and disease.
These defenses include the following:
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normal functioning mucosal membranes
normal immune responses
intact skin
-(Pathophysiology, Gutierrez, Peterson)
The two types of immune
responses are nonspecific and
specific.
Nonspecific immune responses
Nonspecific immune response –
the response of the innate immunity
system or what we are born with.
Specific immune response
Specific immune response – the
response based on our ability to
develop antibodies against foreign
substances.
Because the immune system is nonspecific and specific,
the body must be able to distinguish
between foreign substances
and its own tissues.
Immune System Disorders
Immunodeficiency Disorder
and
Autoimmune Disorder
“Immune system disorders
occur when the immune system
responds
in an inappropriate way
(excessive or lacking)”
-Medline Plus,2005
Lymphoid Tissue
 thymus
 lymph
nodes
 tonsils
 parts
of the spleen and
gastrointestinal tract
 bone marrow
Lymphocytes
There are two groups of lymphocytes
called:
T-lymphocytes
and
B-lymphocytes
cellular immunity - T lymphocytes are
sensitized lymphocytes that directly attack
antigens
humoral immunity - B lymphocytes produce
antibodies that attach to the antigen and
make phagocytes and complement proteins
much more efficient in the destruction of
the antigen
-Medline Plus,2005
Human immune system
There are two broad categories for
human immune system disorders:
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immunodeficiency disorders
(lacking)
autoimmune disorders
(excessive)
Immunodeficiency disorders
 can
be congenital or acquired
 can
affect any part of the
immune system
-UMM, 2005
Congenital Immunodeficiency
Disorders
Most commonly, this involves
decreased functioning of T or B
lymphocytes (or both),
or
deficient antibody production
Congenital Immunodeficiency
Disorders
The causes include congenital
(inherited) defects
and
acquired immunodeficiency caused
by a disease that affects the immune
system”
-UMM, 2005
Congenital Immunodeficiency
Disorders
 Congenital
immunodeficiency -
disorders of antibody production
 Congenital
disorders affecting the
T lymphocytes
 Inherited
combined
immunodeficiency affects both T
and B lymphocytes
Acquired Immunodeficiency
-is a result or a complication of an external
causative source.
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common side-effect of chemotherapy
complication of diseases such as HIV and AIDS
malnutrition, particularly with lack of protein
many cancers
people who have had a splenectomy
people with diabetes
increased age
-(UMM, 2005)
Immunodeficiency complications
(symptoms, signs):
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persistent or recurrent infections
-(Merck, 2003)
severe infections, by organisms, that are
normally mild
-(Merck, 2003)
incomplete recovery from illness, poor
response to treatment
-(Adam Encyclopedia, 2004)
increased incidence of cancer or other
tumor growth
-(UMM, 2005)
enlarged liver and spleen -(Merck, 2003)
Treatment of Immunodeficiency
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Drug induced immunodeficiency
– “…..maintain a balance between
suppression of parts of the immune
system and the ability to fight disease
and infection -(Medline Plus, 2005)”.
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protection against infection and
other disease processes -(UMM, 2005)
drugs that increase the efficiency of
the immune system -(UMM, 2005)
Continue…..
Treatment of Immunodeficiency
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drugs to reduce the amount of virus in their
immune system -(UMM, 2005)
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transplantation of thymus tissue
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stem cell transplantation
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-(Merck,
2003)
-(Merck,2003)
prophylactic antibiotic before surgeries or
dental procedures -(Merck,2003)
Prognosis of
Immunodeficiency is variable
based on the type of
immunodeficiency disorder.
Autoimmune Disorder
Autoimmune Disorder is an
overactive immune response
where the body attacks its
own cells.
Continue ……
Autoimmune Disease
Although the cause of autoimmune
disease is not known,
most autoimmune diseases
are most likely the result
of
multiple circumstances.
There are more than 40 human diseases classified
as definite or probable autoimmune diseases.
Examples of autoimmune (or autoimmune-related)
disorders include -(MedlinePlus, 2006):
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Hashimoto’s
thyroiditis
pernicious anemia
Addison’s disease
type 1 diabetes
rheumatoid arthritis
systemic lupus
erythematosus
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dermatomyositis
Sjogren’s syndrome
lupus
erythematosus
multiple sclerosis
myasthenia gravis
Reiter’s syndrome
Grave’s disease
Autoimmune diseases affect
women more often than men.
Almost 79%
of autoimmune disease patients
in the United States
are women -(Wikipedia, 2006).
Symptoms for Autoimmune
disorders
 fatigue
 vertigo
 malaise
–
(nonspecific feeling of not being well)
 fever
or
 low grade temperature
Tests for Autoimmune
Because symptoms are different
according to the specific disorder,
and the organ or tissue affected,
there are a variety of testing
methods.
Treatment of autoimmune disorder
(Medline Plus, 2005):
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treat symptoms according to the type
and severity
control the autoimmune process while
maintaining the ability to fight disease
hormones or other substances normally
produced by the affected organ may
need to be supplemented
assist mobility or other functions may be
needed for disorders that affect the
bones, joints or muscles.
Acquired Immunodeficiency
syndrome (AIDS)
Acquired Immunodeficiency
syndrome (AIDS)
AIDS (acquired immunodeficiency
syndrome) is the final stage of
HIV disease.
The Center for Disease Control and Prevention
(CDC)
has
classified AIDS as
“beginning when a person with HIV infection
has a CD4 cell count below 200”.
-(Medline Plus, 2006)
A patient is also considered to have AIDS
when numerous opportunistic infections
and cancers
appear to the person with the HIV infection.
AIDS
“Although AIDS was not recognized as
a new clinical syndrome until 1981,
researchers examining
the earlier medical literature,
identified cases appearing to fit the
AIDS surveillance definition
as early as the 1950s and1960s”
-(HIVInSite, 2003)
HIV infection is transmitted by:
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sexual intercourse (heterosexual and
homosexual)
by blood and blood products
perinatally from infected mother to child
(prepartum, intrapartum, and
postpartum via breast milk)
……..(McGraw-Hill, 2005)
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sharing needles with an infected person
The associated symptoms for
AIDS:
Symptoms are primarily the result of
infections that do not normally
develop in people with healthy
immune systems.
These infections are called
opportunistic infections.
The associated symptoms for
AIDS:
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“cough and shortness of breath”
“seizures and lack of coordination”
“difficult or painful swallowing”
“mental symptoms such as
confusion and forgetfulness”
“severe and persistent diarrhea”
-(Medline
Plus, 2006)
Continue…..
The associated symptoms
for AIDS:
“fever”
 “vision loss”
 “nausea, abdominal cramps, and
vomiting”
 “weight loss and extreme fatigue”
 “severe headaches with neck stiffness”
 “coma”
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-(Medline Plus, 2006)
The common means for diagnosis of
AIDS
–ELISA – (enzyme-linked immunoassay)
This is the screening test.
–Western blot – This is the
confirmatory test.
continue…..
AIDS
Newly infected people may have symptoms
which include:
 fever
 headache
 enlarged lymph glands in the neck
 Malaise
These symptoms can disappear on their
own, within a few weeks.
continue…..
AIDS
“Science has determined when each
progressive opportunistic infections
and cancers appear, based on the CD4
count”.
-(Medline
Plus, 2006)
“CD4 count below 350/ml (Medline Plus,
2006)”:
– “herpes simplex virus occurs more
frequently than ever before
– tuberculosis
– oral or vaginal thrush
– herpes zoster
– Non-Hodgkins lymphoma”
-(Medline Plus, 2006)
“CD4 count below 200/ml (Medline Plus,
2006)”
– “Pneumocystis carinii pneumonia, PCP
pneumonia
– candida esophagitis- yeast infection of
the esophagus
-(Medline
Plus, 2006)”
“CD4 count below 100/ml
(Medline Plus, 2006)”
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“Cryptococcal meningitis- infection of the
brain by this fungus
AIDS dementia
toxoplasmosis encephalitis – infection of the
brain by this parasite, which is frequently
found in cat feces
progressive multifocal leukoencephalopathy –
viral disease of the brain
wasting syndrome – extreme weight loss and
anorexia caused by HIV”
-(Medline Plus, 2006)
“CD4 count below 50/ml (Medline Plus, 2006)”
– “mycobacterium avium – blood
infection by a bacterium related to
tuberculosis
– cytomegalovirus infection – a viral
infection that can affect almost any
organ system, especially the eyes”
-(Medline Plus, 2006)
Complications as a result of
Trauma-AIDS
Pathology resulting for trauma can
undergo any number of pathologic
processes.
 Infection is always a concern.
 When treating a patient with HIV/AIDS an
attempt to “…reduce co-factors that may
contribute to immune compromise”
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-(Pathophysiology, Gutierrez, Peterson)
Co-factors that may contribute to
immune compromise
 “protein-calorie
malnutrition…
 pregnancy….
 stress….
alcohol…
 intravenous
and recreational
drug use…..”
-(Pathophysiology, Gutierrez, Peterson)”
Characteristic CT and MRI manifestations
- AIDS
CT and MRI manifestations of the AIDS
pathology depend on the system
affected by the syndrome.
– Multiple systems can be affected.
– “The role of imaging methods in the diagnosis of diseases
associated with HIV infection depends on such factors as
 cost,
 availability,
 and expertise of the clinician or radiologist interpreting the
image.”
-(HIVInsite, Goodman, 2006)
– Abscesses can be located in any area.
Gastrointestinal
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“CT scanning may provide information
about intraluminal as well as solid organ
or lymph node disease.
-(HIVInsite, Goodman2006)”
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The most common CT findings are:
– enlarged retroperitoneal and mesenteric lymph
nodes (42%)
– hepatomegaly (50%)
– splenomegaly (46%)
– small bowel wall thickening (14%)
-(HIVInsite, Goodman, 2006)
Copyright General Electric Company 1997-2006 | GE Healthcare
Copyright General Electric Company 1997-2006 | GE Healthcare
Copyright General Electric Company 1997-2006 | GE Healthcare
Copyright General Electric Company 1997-2006 | GE Healthcare
Copyright General Electric Company 1997-2006 | GE Healthcare
Respiratory
 “Pneumocystis
carinii is a common
organism found both in soil and in
living spaces that does not cause
illness in people with a normal
immune system, this organism
multiplies rapidly and causes
pneumonia”.
-(Pathophysiology, Gutierrez, Peterson)
Radiology, Feb 2000; 214: 427 - 432.
Radiology, Feb 2000; 214: 427 - 432.
Radiology, Feb 2000; 214: 427 - 432.
Radiology, Aug 2002; 224: 493 - 502.
Radiology, Aug 2002; 224: 493 - 502.
Radiology, Aug 2002; 224: 493 - 502.
Central Nervous System
“In patients with advanced HIV disease,
neurologic signs and symptoms are
caused by a variety of central
nervous system (CNS)
 infections,
 tumors, and
 direct effects of HIV on neural tissue”
-(HIVInsite, Goodman, 2006)
RadioGraphics, Jul 2004; 24: 1029 1049
Central Nervous System
Continue……
“MRI appears more sensitive than CT
scanning in the detection of HIV related
CNS pathology.
 Some researchers believe that MRI is the
method of choice for all HIV related CNS
pathology, and obviates CT scanning in
most cases”.
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Goodman, 2006
-HIVInsite,
Primary CNS lymphoma is an entity that
was rarely encountered previously, and it
accounted for only 1%–3% of CNS
neoplasms prior to 1978. However,
incidence has increased drastically since
the onset of the acquired immunodeficiency
syndrome, or AIDS, epidemic, and CNS
lymphomas now represent up to 15% of all
brain tumors at some institutions.
Radiology, Jul 2002; 224: 177 - 183.
Radiology, Jul 2002; 224: 177 - 183.
ogy, Jul 2002; 224: 177 - 183.
Radiology, Oct 2005; 237: 265 - 273.
Radiology, Oct 2005; 237: 265 - 273.
Hepatobiliary System
“Infections of the liver and biliary
system with any of a number of
organisms may result in solitary or
multiple hepatic abscesses or
different forms of biliary
involvement, including papillary
stenosis and sclerosing cholangitis”.
-(HIVInsite,
Goodman, 2006)”.
Liver disease may be diagnosed
with:
CT
Ultrasound
Biliary disease may be diagnosed
with:
 CT,
 Ultrasound
or
 Endoscopic
Retrograde
Cholangiopancreatography (ERCP)
-(HIVInsite,
Goodman, 2006)
Peliosis hepatis is the term used for liver
infection by B henselae.
This condition occurs almost exclusively in
patients with acquired immunodeficiency
syndrome (AIDS).
The mechanism of transmission is
unknown, but involvement by animal or
insect vectors has been postulated.
-RadioGraphics, Jul 2004; 24: 937 - 955.
RadioGraphics, Jul 2004; 24: 937 - 955.
RadioGraphics, Jul 2004; 24: 937 - 955.
RadioGraphics, Jul 2004; 24: 937 - 955.
Radiographic Procedures and
Interventional Techniques
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CT and HDCT (High Definition Computer
Tomography) are often beneficial when
diagnosing opportunistic diseases, caused by
AIDS.
Follow up may sometimes be done with routine
chest x-ray or CT.
“In some cases, needle aspiration or excisional
biopsy may be necessary to rule out lymphoma,
KS, mycobacterial disease, or other infection”
-HIVInsite, Goodman, 2006
Systemic Lupus Erythematosus
(SLE)
Systemic Lupus Erythematosus
(SLE)
 Systemic
Lupus Erythematosus (SLE)
is classified with the group of
diseases involving connective
tissues; formerly termed collagen
vascular disease.
-McGraw-Hill, 2000
Systemic Lupus Erythematosus
(SLE)
 Connective
tissue diseases have
many overlapping symptoms which
makes identifying the specific
disease difficult.
-McGraw-Hill, 2000
Connective tissue diseases
include:
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Lupus erythematosus
systemic vasculitis
Scleroderma
Systemic sclerosis
Polymyositis
Sjogren’s syndrome
-McGraw-Hill, 2000
Each of the preceding diseases can
involve multiple organ systems and
is often coupled with various
immunologic abnormalities.
-(McGraw-Hill, 2000).
Cause of Systemic Lupus
Erythematosus –
1. In most cases of SLE, the individual has
antibodies present in the blood serum
which are not normally present.
-McGraw-Hill, 2000
2. A genetic predisposition to the
development of SLE exists.
-eMedicine, 2006
CONTINUE.....
3. Except for drug-related lupus, the
cause of systemic lupus and its
variants is not known; thus, a
rational basis for cure does not
exist.
-McGraw-Hill, 2000
4. If a mother has SLE, her daughter’s risk
of developing the disease is 1:40, and her
son’s risk is 1:250
-eMedicine, 2006
continue….
5. “The antibodies may be produced
that can react against the body’s:
– blood cells
– organs
– and tissues
-MedlinePlus,
2004
continue….
6. “The number and variety of antibodies that
can appear in lupus are greater than those
in any other disorder”
-Merck, 2003
7. Many researchers suspect it occurs
following infection with an organism that
looks similar to particular proteins in the
body, which are later mistaken for the
organism and wrongly targeted for attack”.
-MedlinePlus,
2004
CONTINUE……
8. Drug induced Lupus can occur from
medications used to treat heart disease
and tuberculosis.
9. Drug induced lupus usually disappears
after the drug is discontinued.
-McGraw-Hill,
2000
Associated signs and symptoms
1.”The symptoms for SLE vary from person to
person.”
-Merck, 2003
2. 90% of the people with Lupus are young
women in their late teens to 30’s.
3. Lupus occurs in all parts of the world but may be
more common in African Americans and in
Asians.
4. “The manifestations and course of systemic lupus
vary greatly from one individual to another and
even in one person over time.”
-(McGraw-Hill, 2000)”.
5. SLE can involve:
– joints (arthralgias-intermittient joint
pain or acute polyarthritis)
– kidneys
– mucous membranes (gastrointestinal
system)
– blood vessel walls (including those of
the musculoskeletal system)
– skin
– nervous system
– heart
– lungs
Continue…...
Associated Signs and
Symptoms
6. Symptoms may occur gradually or
they may begin suddenly with
fever, resembling an acute
infection.
-Merck,
2003
7. Additional symptoms which may be associated with
this disease:
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blood in the urine
nose bleed
coughing up blood
swallowing difficulty
patchy skin color
red spots on skin
fingers that change color upon pressure or
in the cold
– numbness and tingling
– mouth sores hair loss
-MedlinePlus, 2004
CONTINUE….
Continue…...
Associated Signs and
Symptoms
8.
abdominal pain
9.
visual disturbances
-MedlinePlus, 2004
-MedlinePlus, 2004
10. “Widespread enlargement of the
lymph nodes is common,
particularly in children, young
adults, and in African Americans
of all ages”.
-Merck, 2003
11. “For many women, lupus flare ups occur during
the second half of the menstrual cycle, with
symptoms disappearing when menstruation
starts”.
12.“Migraine-type headaches, epilepsy, or severe
mental disorder (psychoses) may be the first
abnormalities that are noticed”.
13. “Skin rashes include a butterfly-like redness
across the nose and cheeks (malar butterfly
erythema), raised bumps or patches of thin skin,
and red, flat or raised areas on the face and sun
exposed areas of the neck, upper chest,
and elbows”.
Merck, 2003
14. Ulcers occur on mucus membranes, such as
the gums, inside the nose, roof of the mouth,
inside the cheeks. Merck, 2003
15. Alopecia
16. pain when breathing deeply (recurring
inflammation of the pleura)
17. chest pain due to pericarditis (more serious
but rare effects on the heart include angina
due to coronary artery vasculitis, fibrosing
myocarditis)
18. sensitivity to sunlight (photosensitivity)
Common Means of Diagnosis
SLE is can not be diagnosed by doing
any one laboratory test.
Several types of laboratory testing can
be done to help confirm a diagnosis
of Systemic Lupus Erythematosus.
“The diagnosis of SLE is based upon the presence of at
least four out of eleven typical characteristics of the
disease”
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“antinuclear antibody
(ANA)
panel”
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“rheumatoid factor”

“urine protein”
“ESR”

“chest x-ray showing
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pleuritis or pericarditis”
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“CBC”
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“WBC count”
“serum globulin
electrophoresis”
“serum protein
electrophoresis”

“cryoglobulins”

“Coombs’ test”
MedlinePlus, 2004)
“The diagnosis of SLE is based upon the
presence of at least four out of eleven typical
characteristics of the disease”
Continue:
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“complement component 3
(C3)”

“characteristic skin rash or
lesions”
“complement”
“antithyroid microsomal
antibody”

“chest sounds which reveal
heart friction rub or pleural
friction rub”
“antithyroglobulin antibody”
“antimitochondrial
antibody”
“anti-smooth muscle
antibody”

“neurological examination”

“kidney biopsy”
-MedlinePlus, 2004
Complications of SLE:
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Complications associated with SLE
depend on the affected systems and on
the severity of the disease.
“Surgical procedures and pregnancy are
more complicated for people who have
lupus, and they require close medical
supervision”.
“If inflammation of the blood vessels at
the back of the eye occurs, doctors give
prompt treatment with an
immunosuppressive drug because of the
high risk of blindness”.
Merck, 2003
Complications of SLE
Complications associated with SLE
depend on the affected systems and
on the severity of the disease.
 Surgical procedures and pregnancy
are more complicated
 Retinitis-promt treatment necessary
to prevent blindness
 Blockage of arteries in the brain or
lung due to thrombosis
Complications of SLE continue…
Kidney involvement
 Myocarditis
 Lupus pneumonitis
 Thrombocytopenia
 Ischemia
 Complications of high dose glucocorticoid
therapy
 Complications of cytotoxic agents

-(Merck, 2003)
Characteristic Imaging
Manifestations

Imaging methods are chosen according to
the area of investigation
SLE presents with various radiologic manifestations:
–
–
–
–
–
–
Respiratory
Cardiovascular
Gastrointestinal
Genitourinary
Musculoskeletal
Neurological
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
Characteristic Imaging
Manifestations continue……..
 there
are no universally accepted
imaging criteria for the diagnosis of
SLE
 not all SLE patients need imaging
because many will present with
systemic findings
 may help direct management when
there are complications related to
therapy
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
Characteristic Imaging
Manifestations continue……..

In a patient with a known diagnosis of
SLE, imaging is often performed to
determine:
1. the extent and severity of disease and to,
2. monitor the myriad complications that arise from the
disease and,
3. it’s therapy.
4.
…imaging may be important for prompt diagnosis of and
initiation of therapy for complications of SLE
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
Gastrointestinal


The most common CT finding in patients with SLE
and acute abdominal pain is ischemic bowel
disease
Pancreatitis in SLE may be due to vasculitis,
ischemia of small pancreatic vessels, immune
complex deposition, or a combination of these
entities.
Gastrointestinal
continue…..
 CT
images of patients with SLE, are
typically evaluated for the following
radiological signs:
 ischemia,
bowel wall changes
 mesenteric changes
 fluid collection
 retroperitoneal lymphadenopathy
 peritoneal enhancement
 hepatomengaly
 changes in other abdominal organs
 pancreatitis
Gastrointestinal

continue…….
“SLE may involve any portion of the
gastrointestinal system. Nonspecific and vague
abdominal pain is seen in 10%–37% of patients
with SLE and may be due to vasculitis,
obliterative vascular thrombosis resulting in
ischemic bowel, or immune complex deposition of
autoantibodies in tissues, eliciting an
inflammatory response. Immunosuppressants
such as azathioprine and prednisone can also
induce abdominal symptoms and have been
implicated in pancreatitis.”
-RadioGraphics 2004; 24:1069-1086 © RSNA, 2004.
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
Copyright © 2005, Radiological Society of North America, Inc.
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
Respiratory


“The risk of pulmonary infection is three times
higher in patients with SLE than in the general
population due to intrinsic immunologic
abnormalities…..” “Recurrent pulmonary
infections can lead to bronchiectasis and
respiratory compromise.”
“Imaging is often performed in patients with a
known diagnosis of SLE to determine the extent
and severity of disease, which depend on the
extent of organ involvement, and to monitor
complications.
-RadioGraphics 2004;24:1069-1086© RSNA, 2004
Respiratory

continue…….
“Pleural effusions are the most common
manifestation of SLE in the respiratory
system and are bilateral in approximately
50% of patients.”
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004

“Alveolar hemorrhage is a potentially
catastrophic complication of systemic
lupus erythematosus.”
-(American College of Chest Physicians, Chest journal, 2006)
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA,
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
Central Nervous System
Neurologic changes can occur secondary
to to lupus.
 15% of patients experience CVA’s,
(cerebral vascular accident) and 20% of
all patients develop some type of seizure
disorder.
 These CNS manifestations can limit the
patient’s ability to care for themselves.
Lupus therefore has a significant effect on
the quality of life for those with this
disease.

Central Nervous System
continue……
Brain imaging is most often conclusive
when using MRI in comparison to CT.
 “All lesions seen on CT were also visible on
MR; however, MR proved to be
substantially more sensitive. Many lesions
not visible on CT were noted on MR, and
in general, MR demonstrated the
abnormalities with greater clarity”.

-(American College of Physicians, Chest journal, 1985)
Central Nervous System
continue……

“Focal lesions were demonstrated on MR
imaging in eight patients with systemic
lupus erythematosus and recent onset of
neuropsychiatric symptoms.
Corresponding findings were visible in only
two of seven patients who had CT scans”.
-(American College of Physicians, Chest journal, 2006)

Immunosuppressive therapy for the
treatment of SLE can reduce the immune
response leaving the patient vulnerable for
cerebral abscesses.
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004
-RadioGraphics 2004;24:1069-1086 © RSNA, 2004