MR Imaging of Ankylosing Spondylitis

So-Yeon Lee; Won-Hee Jee

doi:10.4078/jkra.2010.17.4.340

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Lee and Jee: MR Imaging of Ankylosing Spondylitis

Original Article

J Korean Rheum Assoc 2010;17(4):340-347.

Published online: 23 December 2010

DOI: https://doi.org/10.4078/jkra.2010.17.4.340

MR Imaging of Ankylosing Spondylitis

So-Yeon Lee¹, Won-Hee Jee²

¹Department of Radiology, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea

²Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea

Received 3 December 20107 December 2010 Accepted 8 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Magnetic resonance imaging (MRI) is a highly reliable tool for diagnosing ankylosing spondylitis. MRI can identify cartilage abnormalities, subcortical erosions, bone marrow edema with inflammation, and synovial enhancement. Subchondral sclerosis and juxta-articular fat deposition are noted in the chronic stage of ankylosing spondylitis. Spinal changes associated with spondyloarthropathy are florid anterior spondylitis (or Romanus lesion), florid diskitis (Anderson lesion), ankylosis, and arthritis of the apophyseal and costovertebral joints. A MRI grading system for inflammation in sacroiliac joints and the spine could help clinicians evaluate the anti-inflammatory efficacy of therapeutics. Newer technologies based on MRI are aimed at broadening the diagnostic scope and facilitating the quantification of active inflammation but still require extensive validation.

Keywords: Ankylosing spondylitis, Spondyloarthropathies, Sacroiliitis, Magnetic resonance imaging

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Fig. 1.

Bilateral sacroiliitis in a 35-year-old man with ankylosing spondylitis. (A) Oblique views of sacroiliac joints show subcortical erosions, subchondral sclerosis, and joint space narrowing at the right sacroiliac joint (grade 3) and subchondral sclerosis at the left sacroiliac joint (grade 2). (B) Oblique coronal T1-weighted magnetic resonance image (MRI) of the synovial portion of the sacroiliac joints shows subchondral sclerosis (arrows) at bilateral sacroiliac joints. (C) Oblique coronal fat-suppressed T2-weighted MRI at the same level shows cartilage signal abnormalities (arrow) in the right sacroiliac joint and bone marrow edema (arrowheads) in bilateral sacroiliac joints. (D) Oblique coronal fat-suppressed 3D gradient-echo MRI reveals multiple subcortical erosions (arrowheads) in both sacroiliac joints. (E) Oblique coronal fat-suppressed contrast-enhanced T1-weighted MRI at the same level shows slight synovial enhancement (arrow) in the right sacroiliac joint.

Fig. 2.

Romanus lesion in a 34-year-old man with ankylosing spondylitis. (A) Lateral view of the lumbar spine shows “shiny corner sign” (arrow) at L1 vertebral body. (B) Sagittal T1-weighted magnetic resonance image (MRI) of the thoracic spine shows multiple band-like lesions (arrows) at the junctions between intervertebral discs and vertebral bodies, suggesting enthesitis. Multiple hypointense lesions are visible in anterior portions of thoracic vertebral bodies. (C, D) These vertical lesions are seen as hyperintense lesions (MR corner sign) on fat-suppressed T2-weighted image (arrowheads) and contrast enhancement (arrowheads) on fat-suppressed contrast-enhanced T1-weighted image, suggesting osteitis.

Fig. 3.

Arthritis of apophyseal joints in a 36-year-old man with ankylosing spondylitis. (A) Lateral view of thoracolumbar spine shows no abnormality in facet joints. (B, C) There are multiple areas (arrowheads) with hypointense signals on the T1-weighted image (B) and hyperintense signal on fat-suppressed the T2-weighted image (C) at multilevel apophyseal joints, suggesting arthritis.

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