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

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.