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MRI of the Sacroiliac Joints in Patients with Moderate to Severe Ankylosing Spondylitis

Miriam A. Bredella1,2, Lynne S. Steinbach1, Stephanie Morgan3, Michael Ward4 and John C. Davis3

1 Department of Radiology, University of California, San Francisco, San Francisco, CA.
2 Present address: Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Yawkey Bldg., 6400 (6E), Boston, MA 02114.
3 Department of Internal Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, CA.
4 National Institute of Arthritis and Musculoskeletal Skin Diseases, National Institutes of Health, Bethesda, MD.


Figure 1
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  		Fig. 1A —28-year-old man with ankylosing spondylitis for 10 years. Laboratory results and clinical findings were as follows: C-reactive protein, 7.3 mg/L; erythrocyte sedimentation rate, 5 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 80.0; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 60.2; inflammatory back pain score, 94; nocturnal back pain score, 83; total back pain score, 82. Radiographs show indistinct sacroiliac joint with erosions.

 

Figure 2
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  		Fig. 1B —28-year-old man with ankylosing spondylitis for 10 years. Laboratory results and clinical findings were as follows: C-reactive protein, 7.3 mg/L; erythrocyte sedimentation rate, 5 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 80.0; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 60.2; inflammatory back pain score, 94; nocturnal back pain score, 83; total back pain score, 82. Coronal T1-weighted MR image shows subchondral fatty marrow changes (arrows). There is irregularity of sacroiliac joint.

 

Figure 3
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  		Fig. 1C —28-year-old man with ankylosing spondylitis for 10 years. Laboratory results and clinical findings were as follows: C-reactive protein, 7.3 mg/L; erythrocyte sedimentation rate, 5 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 80.0; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 60.2; inflammatory back pain score, 94; nocturnal back pain score, 83; total back pain score, 82. Coronal fat-saturated contrast-enhanced T1-weighted image shows small foci of enhancement at inferior sacroiliac joint (arrows).

 

Figure 4
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  		Fig. 1D —28-year-old man with ankylosing spondylitis for 10 years. Laboratory results and clinical findings were as follows: C-reactive protein, 7.3 mg/L; erythrocyte sedimentation rate, 5 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 80.0; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 60.2; inflammatory back pain score, 94; nocturnal back pain score, 83; total back pain score, 82. Coronal STIR image shows focal T2 prolongation at inferior sacroiliac joint (arrows).

 

Figure 5
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  		Fig. 1E —28-year-old man with ankylosing spondylitis for 10 years. Laboratory results and clinical findings were as follows: C-reactive protein, 7.3 mg/L; erythrocyte sedimentation rate, 5 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 80.0; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 60.2; inflammatory back pain score, 94; nocturnal back pain score, 83; total back pain score, 82. Edema (arrows) is not well visualized on coronal fat-saturated T2-weighted image.

 

Figure 6
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  		Fig. 2A —34-year-old woman with ankylosing spondylitis for 21 years. Laboratory results and clinical findings were as follows: C-reactive protein, 6 mg/L; erythrocyte sedimentation rate, 7 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 77.3; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 75.2; inflammatory back pain score, 100; nocturnal back pain score, 24; total back pain score, 47. Radiograph shows suspicious changes of sacroiliac joint.

 

Figure 7
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  		Fig. 2B —34-year-old woman with ankylosing spondylitis for 21 years. Laboratory results and clinical findings were as follows: C-reactive protein, 6 mg/L; erythrocyte sedimentation rate, 7 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 77.3; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 75.2; inflammatory back pain score, 100; nocturnal back pain score, 24; total back pain score, 47. Coronal T1-weighted MR image shows normal findings.

 

Figure 8
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  		Fig. 2C —34-year-old woman with ankylosing spondylitis for 21 years. Laboratory results and clinical findings were as follows: C-reactive protein, 6 mg/L; erythrocyte sedimentation rate, 7 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 77.3; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 75.2; inflammatory back pain score, 100; nocturnal back pain score, 24; total back pain score, 47. Coronal fat-saturated contrast-enhanced T1-weighted image shows moderate enhancement (arrows).

 

Figure 9
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  		Fig. 2D —34-year-old woman with ankylosing spondylitis for 21 years. Laboratory results and clinical findings were as follows: C-reactive protein, 6 mg/L; erythrocyte sedimentation rate, 7 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 77.3; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 75.2; inflammatory back pain score, 100; nocturnal back pain score, 24; total back pain score, 47. Coronal STIR image shows mild bilateral inferior edema of sacroiliac joint (arrows).

 

Figure 10
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  		Fig. 3A —43-year-old man with ankylosing spondylitis for 20 years. Laboratory results and clinical findings were as follows: C-reactive protein, 17.5 mg/L; erythrocyte sedimentation rate, 34 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 42.8; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 41.8; inflammatory back pain score, 41.5; nocturnal back pain score, 62; total back pain score, 63. Radiograph shows fusion of sacroiliac joint.

 

Figure 11
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  		Fig. 3B —43-year-old man with ankylosing spondylitis for 20 years. Laboratory results and clinical findings were as follows: C-reactive protein, 17.5 mg/L; erythrocyte sedimentation rate, 34 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 42.8; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 41.8; inflammatory back pain score, 41.5; nocturnal back pain score, 62; total back pain score, 63. Axial T1-weighted MR image shows sclerosis and fusion of sacroiliac joint (arrows).

 

Figure 12
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  		Fig. 3C —43-year-old man with ankylosing spondylitis for 20 years. Laboratory results and clinical findings were as follows: C-reactive protein, 17.5 mg/L; erythrocyte sedimentation rate, 34 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 42.8; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 41.8; inflammatory back pain score, 41.5; nocturnal back pain score, 62; total back pain score, 63. Coronal T1-weighted MR image shows sclerosis and fusion of sacroiliac joint (arrows).

 

Figure 13
View larger version (132K):

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  		Fig. 3D —43-year-old man with ankylosing spondylitis for 20 years. Laboratory results and clinical findings were as follows: C-reactive protein, 17.5 mg/L; erythrocyte sedimentation rate, 34 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 42.8; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 41.8; inflammatory back pain score, 41.5; nocturnal back pain score, 62; total back pain score, 63. Coronal fat-saturated contrast-enhanced T1-weighted image shows bilateral enhancement of sacroiliac joint (arrows).

 

Figure 14
View larger version (117K):

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  		Fig. 3E —43-year-old man with ankylosing spondylitis for 20 years. Laboratory results and clinical findings were as follows: C-reactive protein, 17.5 mg/L; erythrocyte sedimentation rate, 34 mm/h; Bath Ankylosing Spondylitis Functional Index (BASFI), 42.8; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 41.8; inflammatory back pain score, 41.5; nocturnal back pain score, 62; total back pain score, 63. Coronal STIR image shows mild subchondral edema (arrows).

 

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