DOI: 10.1148/rg.253045117
Spinal Changes in Patients with Spondyloarthritis: Comparison of MR Imaging and Radiographic Appearances1
Kay-Geert A. Hermann, MD,
Christian E. Althoff, MD,
Udo Schneider, MD,
Svenda Zühlsdorf,
Alexander Lembcke, MD,
Bernd Hamm, MD and
Matthias Bollow, MD
1 From the Departments of Radiology (K.G.A.H., C.E.A., S.Z., A.L., B.H.) and Rheumatology and Clinical Immunology (U.S.), Charité Medical School, Campus Mitte, Schumannstrasse 20/21, 10117 Berlin, Germany; and the Department of Radiology, Augusta Hospital, Bochum, Germany (M.B.). Presented as an education exhibit at the 2003 RSNA Scientific Assembly. Received May 24, 2004; revision requested August 6 and received September 20; accepted September 21. All authors have no financial relationships to disclose.
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Figure 1a. Spondylitis (active Romanus lesions) in a 34-year-old patient with ankylosing spondylitis. Sagittal T1-weighted turbo spin-echo (a) and STIR (b) images of the thoracic spine show florid Romanus lesions (anterior spondylitis) at T6–7, T8–9, and T10–11 (arrowheads). The lesions are seen at the anterior vertebral edges as a circumscribed increase in signal intensity on the STIR image and a decrease in signal intensity on the T1-weighted image.
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Figure 1b. Spondylitis (active Romanus lesions) in a 34-year-old patient with ankylosing spondylitis. Sagittal T1-weighted turbo spin-echo (a) and STIR (b) images of the thoracic spine show florid Romanus lesions (anterior spondylitis) at T6–7, T8–9, and T10–11 (arrowheads). The lesions are seen at the anterior vertebral edges as a circumscribed increase in signal intensity on the STIR image and a decrease in signal intensity on the T1-weighted image.
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Figure 2a. Spondylitis (inactive Romanus lesions) in a 39-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar region shows syndesmophytes (arrows) at L3 through S1 and a shiny corner at the superior endplate of L5. (b) On the corresponding T1-weighted fast spin-echo image, the syndesmophyte at L5 (lower long arrow) is barely visible. Postinflammatory fatty bone marrow degeneration of the anterior vertebral edges is seen (short arrows), findings compatible with inactive Romanus lesions. (Fig 2a and 2b reprinted, with permission, from reference 23.)
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Figure 2b. Spondylitis (inactive Romanus lesions) in a 39-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar region shows syndesmophytes (arrows) at L3 through S1 and a shiny corner at the superior endplate of L5. (b) On the corresponding T1-weighted fast spin-echo image, the syndesmophyte at L5 (lower long arrow) is barely visible. Postinflammatory fatty bone marrow degeneration of the anterior vertebral edges is seen (short arrows), findings compatible with inactive Romanus lesions. (Fig 2a and 2b reprinted, with permission, from reference 23.)
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Figure 3a. Spondylodiskitis (inflammatory Andersson lesions) in a 24-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows height reduction of intervertebral disk space, sclerosis of the end-plates at L4–5, erosion (arrow) of the superior endplate of L5 (Andersson lesion), and a syndesmophyte at L4 (arrowhead). (b) Sagittal T1-weighted fast spin-echo image reveals erosive defects of the inferior endplate (arrow) of L4 and superior endplate of L5, as well as signal loss in the surrounding bone marrow. (c) Corresponding STIR image shows increased signal intensity (arrowheads) adjacent to the intervertebral disk (florid Andersson lesion). (d) Sagittal T1-weighted image obtained 26 weeks after treatment with TNF- inhibitor shows increased signal intensity in the former low-signal-intensity areas, findings indicative of postinflammatory fatty bone marrow degeneration. (e) Corresponding STIR image shows complete regression of the former high-signal-intensity changes.
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Figure 3b. Spondylodiskitis (inflammatory Andersson lesions) in a 24-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows height reduction of intervertebral disk space, sclerosis of the end-plates at L4–5, erosion (arrow) of the superior endplate of L5 (Andersson lesion), and a syndesmophyte at L4 (arrowhead). (b) Sagittal T1-weighted fast spin-echo image reveals erosive defects of the inferior endplate (arrow) of L4 and superior endplate of L5, as well as signal loss in the surrounding bone marrow. (c) Corresponding STIR image shows increased signal intensity (arrowheads) adjacent to the intervertebral disk (florid Andersson lesion). (d) Sagittal T1-weighted image obtained 26 weeks after treatment with TNF- inhibitor shows increased signal intensity in the former low-signal-intensity areas, findings indicative of postinflammatory fatty bone marrow degeneration. (e) Corresponding STIR image shows complete regression of the former high-signal-intensity changes.
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Figure 3c. Spondylodiskitis (inflammatory Andersson lesions) in a 24-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows height reduction of intervertebral disk space, sclerosis of the end-plates at L4–5, erosion (arrow) of the superior endplate of L5 (Andersson lesion), and a syndesmophyte at L4 (arrowhead). (b) Sagittal T1-weighted fast spin-echo image reveals erosive defects of the inferior endplate (arrow) of L4 and superior endplate of L5, as well as signal loss in the surrounding bone marrow. (c) Corresponding STIR image shows increased signal intensity (arrowheads) adjacent to the intervertebral disk (florid Andersson lesion). (d) Sagittal T1-weighted image obtained 26 weeks after treatment with TNF- inhibitor shows increased signal intensity in the former low-signal-intensity areas, findings indicative of postinflammatory fatty bone marrow degeneration. (e) Corresponding STIR image shows complete regression of the former high-signal-intensity changes.
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Figure 3d. Spondylodiskitis (inflammatory Andersson lesions) in a 24-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows height reduction of intervertebral disk space, sclerosis of the end-plates at L4–5, erosion (arrow) of the superior endplate of L5 (Andersson lesion), and a syndesmophyte at L4 (arrowhead). (b) Sagittal T1-weighted fast spin-echo image reveals erosive defects of the inferior endplate (arrow) of L4 and superior endplate of L5, as well as signal loss in the surrounding bone marrow. (c) Corresponding STIR image shows increased signal intensity (arrowheads) adjacent to the intervertebral disk (florid Andersson lesion). (d) Sagittal T1-weighted image obtained 26 weeks after treatment with TNF- inhibitor shows increased signal intensity in the former low-signal-intensity areas, findings indicative of postinflammatory fatty bone marrow degeneration. (e) Corresponding STIR image shows complete regression of the former high-signal-intensity changes.
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Figure 3e. Spondylodiskitis (inflammatory Andersson lesions) in a 24-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows height reduction of intervertebral disk space, sclerosis of the end-plates at L4–5, erosion (arrow) of the superior endplate of L5 (Andersson lesion), and a syndesmophyte at L4 (arrowhead). (b) Sagittal T1-weighted fast spin-echo image reveals erosive defects of the inferior endplate (arrow) of L4 and superior endplate of L5, as well as signal loss in the surrounding bone marrow. (c) Corresponding STIR image shows increased signal intensity (arrowheads) adjacent to the intervertebral disk (florid Andersson lesion). (d) Sagittal T1-weighted image obtained 26 weeks after treatment with TNF- inhibitor shows increased signal intensity in the former low-signal-intensity areas, findings indicative of postinflammatory fatty bone marrow degeneration. (e) Corresponding STIR image shows complete regression of the former high-signal-intensity changes.
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Figure 4a. Insufficiency fracture (noninflammatory Andersson lesion) in a 60-year-old patient with a long history of ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows gross bony destruction of the T12-L1 disk with irregular contours of the endplates and increased sclerosis of adjacent vertebral bodies (large arrow). Ankylosis of inferior articular segments (small arrows) and barreling of L3 through L5 are seen. (b) Sagittal contrast-enhanced T1-weighted fast spin-echo image shows subacute hematoma with low signal intensity and marginal contrast enhancement (arrowheads), indicative of peripheral revascularization at T12-L1 (large arrow). Ankylosis of the superior and inferior segments is seen (small arrows). The fracture extends to the posterior elements. (Fig 4a and 4b reprinted, with permission, from reference 23.)
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Figure 4b. Insufficiency fracture (noninflammatory Andersson lesion) in a 60-year-old patient with a long history of ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows gross bony destruction of the T12-L1 disk with irregular contours of the endplates and increased sclerosis of adjacent vertebral bodies (large arrow). Ankylosis of inferior articular segments (small arrows) and barreling of L3 through L5 are seen. (b) Sagittal contrast-enhanced T1-weighted fast spin-echo image shows subacute hematoma with low signal intensity and marginal contrast enhancement (arrowheads), indicative of peripheral revascularization at T12-L1 (large arrow). Ankylosis of the superior and inferior segments is seen (small arrows). The fracture extends to the posterior elements. (Fig 4a and 4b reprinted, with permission, from reference 23.)
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Figure 5a. Arthritis of the zygapophyseal joints in a 32-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the thoracic spine shows a posterior shiny corner at T9–10. (b) Sagittal T1-weighted fast spin-echo image shows circumscribed loss of signal intensity in the area of the vertebral arch (arrows) and zygapophyseal joints. (c) Sagittal contrast-enhanced fat-saturated T1-weighted image shows pronounced enhancement of the vertebral arch, articular processes, and adjacent soft tissue (arrows), findings suggestive of arthritis of apophyseal joints. Marginal spondylitis is seen (arrowheads). (d) Transverse contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows enhancement near the costovertebral joint (arrow), a finding indicative of synovitis with concomitant osteitis of the adjacent rib and vertebral portions (arrowheads).
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Figure 5b. Arthritis of the zygapophyseal joints in a 32-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the thoracic spine shows a posterior shiny corner at T9–10. (b) Sagittal T1-weighted fast spin-echo image shows circumscribed loss of signal intensity in the area of the vertebral arch (arrows) and zygapophyseal joints. (c) Sagittal contrast-enhanced fat-saturated T1-weighted image shows pronounced enhancement of the vertebral arch, articular processes, and adjacent soft tissue (arrows), findings suggestive of arthritis of apophyseal joints. Marginal spondylitis is seen (arrowheads). (d) Transverse contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows enhancement near the costovertebral joint (arrow), a finding indicative of synovitis with concomitant osteitis of the adjacent rib and vertebral portions (arrowheads).
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Figure 5c. Arthritis of the zygapophyseal joints in a 32-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the thoracic spine shows a posterior shiny corner at T9–10. (b) Sagittal T1-weighted fast spin-echo image shows circumscribed loss of signal intensity in the area of the vertebral arch (arrows) and zygapophyseal joints. (c) Sagittal contrast-enhanced fat-saturated T1-weighted image shows pronounced enhancement of the vertebral arch, articular processes, and adjacent soft tissue (arrows), findings suggestive of arthritis of apophyseal joints. Marginal spondylitis is seen (arrowheads). (d) Transverse contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows enhancement near the costovertebral joint (arrow), a finding indicative of synovitis with concomitant osteitis of the adjacent rib and vertebral portions (arrowheads).
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Figure 5d. Arthritis of the zygapophyseal joints in a 32-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the thoracic spine shows a posterior shiny corner at T9–10. (b) Sagittal T1-weighted fast spin-echo image shows circumscribed loss of signal intensity in the area of the vertebral arch (arrows) and zygapophyseal joints. (c) Sagittal contrast-enhanced fat-saturated T1-weighted image shows pronounced enhancement of the vertebral arch, articular processes, and adjacent soft tissue (arrows), findings suggestive of arthritis of apophyseal joints. Marginal spondylitis is seen (arrowheads). (d) Transverse contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows enhancement near the costovertebral joint (arrow), a finding indicative of synovitis with concomitant osteitis of the adjacent rib and vertebral portions (arrowheads).
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Figure 6a. Enthesitis in a 47-year-old patient with ankylosing spondylitis. (a) Sagittal unenhanced T1-weighted fast spin-echo image shows thickening of the supraspinal ligament from C7 through T3 (arrows). (b) Sagittal contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows pronounced enhancement in the area of the interspinal and supraspinal ligaments (arrows), a finding indicative of enthesitis. (Patient was positioned on a gel cushion to improve signal-to-noise ratio.)
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Figure 6b. Enthesitis in a 47-year-old patient with ankylosing spondylitis. (a) Sagittal unenhanced T1-weighted fast spin-echo image shows thickening of the supraspinal ligament from C7 through T3 (arrows). (b) Sagittal contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows pronounced enhancement in the area of the interspinal and supraspinal ligaments (arrows), a finding indicative of enthesitis. (Patient was positioned on a gel cushion to improve signal-to-noise ratio.)
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Figure 7a. Ankylosis and syndesmophytes in a 36-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows anterior syndesmophytes at L3–4 and L4–5 (arrows) and a defect of the epiphyseal ring at the anterior edge of L3 (arrowhead). Beginning ossification of intervertebral spaces L1–2 and L2–3 is evident. (b) On the T1-weighted turbo spin-echo image, syndesmophytes are not seen. (c) Sagittal contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows enhancement in the area of the epiphyseal rings at L4–5 (arrowheads), a finding representing a Romanus lesion. Subtle enhancement (arrow) of intervertebral disk L4–5 (an early Andersson lesion) is also seen.
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Figure 7b. Ankylosis and syndesmophytes in a 36-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows anterior syndesmophytes at L3–4 and L4–5 (arrows) and a defect of the epiphyseal ring at the anterior edge of L3 (arrowhead). Beginning ossification of intervertebral spaces L1–2 and L2–3 is evident. (b) On the T1-weighted turbo spin-echo image, syndesmophytes are not seen. (c) Sagittal contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows enhancement in the area of the epiphyseal rings at L4–5 (arrowheads), a finding representing a Romanus lesion. Subtle enhancement (arrow) of intervertebral disk L4–5 (an early Andersson lesion) is also seen.
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Figure 7c. Ankylosis and syndesmophytes in a 36-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar spine shows anterior syndesmophytes at L3–4 and L4–5 (arrows) and a defect of the epiphyseal ring at the anterior edge of L3 (arrowhead). Beginning ossification of intervertebral spaces L1–2 and L2–3 is evident. (b) On the T1-weighted turbo spin-echo image, syndesmophytes are not seen. (c) Sagittal contrast-enhanced fat-saturated T1-weighted turbo spin-echo image shows enhancement in the area of the epiphyseal rings at L4–5 (arrowheads), a finding representing a Romanus lesion. Subtle enhancement (arrow) of intervertebral disk L4–5 (an early Andersson lesion) is also seen.
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Copyright © 2005 by the Radiological Society of North America.
