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Spinal Changes in Patients with Spondyloarthritis: Comparison of MR Imaging and Radiographic Appearances¹

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. Address correspondence to K.G.A.H. (e-mail: kgh{at}charite.de).

Since the advent of highly effective TNF- inhibitors for treating spondyloarthritides, referring rheumatologists have been requesting the sensitive visualization of inflammatory changes not only of the sacroiliac joints but of the entire spine. Given that changes in spondyloarthritis may be very subtle, their visualization by means of magnetic resonance (MR) imaging relies critically on selecting the proper imaging protocol. Spinal changes associated with spondyloarthritis are florid anterior spondylitis (or Romanus lesion), florid diskitis (or Andersson lesion), ankylosis, insufficiency fractures of the ankylosed spine, syndesmophytes, arthritis of the apophyseal and costovertebral joints, and enthesitis of the interspinal ligaments. A comparison of MR imaging findings with those of conventional radiography in individual patients reveals strengths and weaknesses of both modalities. Results of this comparison suggest that syndesmophytes are depicted better with radiography; ankylosis, equally well with both imaging techniques; and all other lesions, better with MR imaging. Classification of the different findings based on the typical signal-intensity changes seen on MR images enables standardized reporting, and scoring the lesions may be helpful in clinical trials.

© RSNA, 2005

Abbreviations: STIR = short inversion time inversion recovery, TNF = tumor necrosis factor

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Invited Commentary • Author’s Response

B. J. Manaster and Kay-Geert A. Hermann
RadioGraphics 2005 25: 569-570. [Full Text] [PDF]

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