Are hyperintense signal increases on cranial MRI a new finding for differential diagnosis in rheumatic diseases?

Year 2025, Volume: 15 Issue: 3, 295 - 301, 15.09.2025

Ayşe Eda Parlak , Esra Taşkıran

https://doi.org/10.16919/bozoktip.1732421

Abstract

Objective:
To retrospectively evaluate demographic and clinical features of patients with rheumatic diseases, analyze cranial magnetic resonance imaging (MRI) findings taken for various reasons, and assess their contribution to diagnosis.
Methods:
Thirty-eight patients followed for rheumatologic diseases between March 2023 and December 2024 were included. Cranial MRI scans performed for reasons such as headache, vertigo, migraine, and cerebrovascular events were reviewed. Hyperintense signal changes were assessed on T2-weighted and Fluid Attenuation Inversion Recovery (FLAIR) images, including lesion location, number, and morphology.
Results:
Of the 38 patients, 22 had Rheumatoid Arthritis (RA), 4 had Sjögren’s syndrome, 9 had Systemic Lupus Erythematosus (SLE), 2 had SLE with multiple sclerosis (MS), and 1 had Ankylosing Spondylitis (AS). Cranial lesions were observed in 32 cases (84.2%). Lesions were most common in RA (18 patients, 81.8%), with 88.9% showing periventricular localization. Among RA patients, 8 had periventricular-cortical/subcortical, 4 had periventricular-juxtacortical, and 2 had only periventricular lesions. In the SLE group, lesions were present in 8 patients (88.8%), and in both SLE-MS cases (100%), all with periventricular localization. Of these, 4 had periventricular-cortical/subcortical and 2 had periventricular-juxtacortical involvement.
Conclusion:
Cranial MRI findings may support diagnosis and symptom evaluation in rheumatic diseases. Nonspecific hyperintense signals, particularly with periventricular distribution, may reflect early central nervous system (CNS) involvement and aid differential diagnosis.

Keywords

Rheumatic diseases , cranial mrı , hyperintense lesions , differential diagnosis , central nervous system involvement , white matter lesions

Ethical Statement

The study was approved by the University of Health Sciences Antalya Training and Research Hospital ethics committee (Approval date and number: 2025/121)

Supporting Institution

yok

Thanks

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Kraniyal MRG'de hiperintens sinyal artışları, romatizmal hastalıkların ayırıcı tanısında yeni bir bulgu mudur?

Abstract

Amaç:
Romatizmal hastalığı olan hastaların demografik ve klinik özelliklerini geriye dönük olarak değerlendirmek, farklı nedenlerle çekilen kranial manyetik rezonans görüntüleme(MRG) bulgularını analiz etmek ve bu bulguların tanıya katkısını araştırmak.
Yöntemler:
Mart 2023- Aralık 2024 tarihleri arasında romatolojik hastalıklar nedeniyle takip edilen 38 hasta çalışmaya dahil edildi. Baş ağrısı, vertigo, migren ve serebrovasküler olay gibi nedenlerle çekilen kranial MRG görüntüleri değerlendirildi. T2 ağırlıklı ve FLAIR (Fluid Attenuation Inversion Recovery) sekanslarında izlenen hiperintens sinyal değişiklikleri; lezyonun yerleşimi, sayısı ve morfolojik özellikleri açısından incelendi.
Bulgular:
38 hastanın 22’si Romatoid Artrit (RA), 4’ü Sjögren sendromu, 9’u Sistemik Lupus Eritematozus (SLE), 2’si SLE-Multipl Skleroz (MS) ve 1’i Ankilozan Spondilit (AS) tanılıydı. Toplam 32 hastada (%84,2) kranial lezyon saptandı. RA’lı 18 hastanın %88,9’unda periventriküler yerleşimli lezyonlar izlendi. Bunların 8’i periventriküler-kortikal/subkortikal, 4’ü periventriküler-juxtakortikal ve 2’si sadece periventriküler yerleşimliydi. SLE grubunda 8 (%88,8), SLE-MS grubunda ise 2 (%100) hastada lezyon saptandı ve tamamı periventriküler yerleşimliydi. Bu lezyonların 4’ü periventriküler-kortikal/subkortikal, 2’si periventriküler-juxtakortikaldi.
Sonuç:
Kranial MRG bulguları, romatizmal hastalıklarda tanı, semptom değerlendirmesi ve ayırıcı tanıya katkı sağlayabilir. Özellikle periventriküler yerleşimli nonspesifik hiperintens sinyaller, erken santral sinir sistemi tutulumunu gösterebilir.

Keywords

Romatizmal hastalıklar , ,kraniyal MRG , ,hiperintens lezyonlar , ,ayırıcı tanı , ,merkezi sinir sistemi tutulum , ,beyaz madde lezyonları

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