EURORAD ESR

Case 15747

Neuropsychiatric systemic lupus erythematosus (NPSLE)

Author(s)
Noor Ali
Richard James

Royal United Hospitals, Clinical Radiology; Combe Park, Bath BA1 3NG; Email:noorali@doctors.org.uk
 
Patient
female, 67 year(s)
 
 
  • Figure 1
    Left cingulate lesion on FLAIR sequence before treatment

    Coronal slice on FLAIR sequence before treatment shows a hyperintensity within the left cingulate gyrus (black arrow). Smaller hyperintensities in the adjacent white matter thought more likely to reflect chronic...

     
    Area of Interest: Neuroradiology brain; Vascular; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
  • Figure 2
    Left cingulate lesion on FLAIR sequence after treatment

    Coronal slice on FLAIR sequence following treatment shows resolution of the previously demonstrated left cingulate gyrus hyperintensity (black arrow). Smaller hyperintensities in the adjacent white matter persist,...

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
  • Figure 3
    Left cingulate lesion on T1 post-contrast imaging before treatment

    Axial T1 image following administration of gadolinium shows a small enhancing lesion in the left cingulate region, with surrounding oedema (arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
  • Figure 4
    Left cingulate lesion on T1 post-contrast imaging after treatment

    Axial T1 post-contrast imaging after treatment shows resolution of the previously demonstrated left cingulate enhancing lesion (arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
  • Figure 5
    Right parietal lesion on FLAIR before treatment

    Coronal FLAIR imaging shows an area of high signal in the right inferior parietal lobule (arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
  • Figure 6
    Right parietal lesion on FLAIR after treatment

    Coronal FLAIR imaging following treatment shows improvement in the previously demonstrated abnormality, with only a small area of residual high signal in the right inferior parietal lobule (arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
  • Figure 7
    Right parietal lesion on T1 post-contrast imaging before treatment

    Axial T1 image following administration of gadolinium before treatment shows patchy enhancement in the right inferior lobule, with surrounding oedema (arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
  • Figure 8
    Right parietal lesion on T1 post-contrast imaging after treatment

    Axial T1 image following administration of gadolinium after treatment shows resolution of the previously demonstrated abnormality in the right inferior parietal lobule (arrow).

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
  • Figure 9
    T2 image following treatment showing microangiopathic disease and cortical atrophy

    Axial T2 slice following treatment shows persistent periventricular high signal (arrows) and global cortical atrophy which is advanced for the patient's age. The appearances are likely to be manifestations of chronic...

     
    Area of Interest: Neuroradiology brain; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Inflammation;
     
     
Coronal slice on FLAIR sequence before treatment shows a hyperintensity within the left cingulate gyrus (black arrow). Smaller hyperintensities in the adjacent white matter thought more likely to reflect chronic microangiopathic disease (white arrows).
 
Coronal slice on FLAIR sequence following treatment shows resolution of the previously demonstrated left cingulate gyrus hyperintensity (black arrow). Smaller hyperintensities in the adjacent white matter persist, confirming probable chronic microangiopathic disease (white arrows).
 
Axial T1 image following administration of gadolinium shows a small enhancing lesion in the left cingulate region, with surrounding oedema (arrow).
 
Axial T1 post-contrast imaging after treatment shows resolution of the previously demonstrated left cingulate enhancing lesion (arrow).
 
Coronal FLAIR imaging shows an area of high signal in the right inferior parietal lobule (arrow).
 
Coronal FLAIR imaging following treatment shows improvement in the previously demonstrated abnormality, with only a small area of residual high signal in the right inferior parietal lobule (arrow).
 
Axial T1 image following administration of gadolinium before treatment shows patchy enhancement in the right inferior lobule, with surrounding oedema (arrow).
 
Axial T1 image following administration of gadolinium after treatment shows resolution of the previously demonstrated abnormality in the right inferior parietal lobule (arrow).
 
Axial T2 slice following treatment shows persistent periventricular high signal (arrows) and global cortical atrophy which is advanced for the patient's age. The appearances are likely to be manifestations of chronic small vessel disease.
 
 
 
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