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CT and MRI of Spine and Sacroiliac Involvement in Spondyloarthropathy

¹ All authors: Service de Radiologie, Hôpital Ambroise Paré, 9 Ave. Charles de Gaulle, 92104 Boulogne, France.

View larger version (16K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Diagram shows different stages of rachidian involvement in spondyloarthropathies. Early inflammatory changes are best shown on MRI (bone marrow edema), although more chronic changes are best depicted on CT (bone erosions, sclerotic changes, syndesmophytes). Pattern of sacroiliac joint involvement is similar.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —31-year-old woman with ankylosing spondylitis: Romanus anterior and posterior spondylitis of thoracic spine. Gadolinium-enhanced sagittal fat-saturated fast spin-echo T1-weighted image shows hyperintense changes at anterior and posterior edges of vertebral endplates (arrows).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —29-year-old man with ankylosing spondylitis: Romanus anterior spondylitis, Andersson spondylodiskitis, zygapophyseal joint arthritis, true ligamentous inflammation, and sacroiliac joint involvement. Sagittal fast spin-echo T1-weighted image shows circumscribed hypointensity of anterior edges of vertebral endplates secondary to both edema and sclerotic changes (arrows).

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —29-year-old man with ankylosing spondylitis: Romanus anterior spondylitis, Andersson spondylodiskitis, zygapophyseal joint arthritis, true ligamentous inflammation, and sacroiliac joint involvement. Sagittal STIR-weighted image shows florid hyperintense Romanus lesions (arrows).

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —29-year-old man with ankylosing spondylitis: Romanus anterior spondylitis, Andersson spondylodiskitis, zygapophyseal joint arthritis, true ligamentous inflammation, and sacroiliac joint involvement. Gadolinium-enhanced sagittal fat-saturated fast spin-echo T1-weighted image confirms vertebral inflammatory changes (arrows) and shows discrete enhancement of interspinal and supraspinal ligaments (arrowheads).

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —29-year-old man with ankylosing spondylitis: Romanus anterior spondylitis, Andersson spondylodiskitis, zygapophyseal joint arthritis, true ligamentous inflammation, and sacroiliac joint involvement. CT scan (sagittal reformation) shows sclerotic changes and erosions of vertebral endplates (arrows).

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —29-year-old man with ankylosing spondylitis: Romanus anterior spondylitis, Andersson spondylodiskitis, zygapophyseal joint arthritis, true ligamentous inflammation, and sacroiliac joint involvement. Sagittal STIR-weighted sequence shows hyperintensity of vertebral endplates adjacent to intervertebral disk, corresponding to Andersson aseptic spondylodiskitis (arrows). Hyperintensity of bone marrow around zygapophyseal joints corresponds to arthritis (arrowheads).

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —29-year-old man with ankylosing spondylitis: Romanus anterior spondylitis, Andersson spondylodiskitis, zygapophyseal joint arthritis, true ligamentous inflammation, and sacroiliac joint involvement. Coronal CT scan of sacroiliac joints shows multiple subchondral erosions (arrows) and sclerosis (arrowheads).

View larger version (65K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3G —29-year-old man with ankylosing spondylitis: Romanus anterior spondylitis, Andersson spondylodiskitis, zygapophyseal joint arthritis, true ligamentous inflammation, and sacroiliac joint involvement. Frontal (G) and lateral (H) radiographs of lumbar spine show discrete erosions and densities of anterior vertebral endplates (arrows, G) and presence of lateral syndesmophytes (arrowheads, H).

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3H —29-year-old man with ankylosing spondylitis: Romanus anterior spondylitis, Andersson spondylodiskitis, zygapophyseal joint arthritis, true ligamentous inflammation, and sacroiliac joint involvement. Frontal (G) and lateral (H) radiographs of lumbar spine show discrete erosions and densities of anterior vertebral endplates (arrows, G) and presence of lateral syndesmophytes (arrowheads, H).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —55-year-old woman with spondyloarthropathy (precise diagnosis not yet established) and ligamentous inflammation. Gadolinium-enhanced sagittal (A), coronal (B), and axial (C) fat-saturated fast spin-echo T1-weighted images of L3–L4 level of lumbar spine show strong enhancement of yellow ligaments (thin arrows) and of interspinal and supraspinal ligaments (thick arrows, B and C), corresponding to inflammatory involvement.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —55-year-old woman with spondyloarthropathy (precise diagnosis not yet established) and ligamentous inflammation. Gadolinium-enhanced sagittal (A), coronal (B), and axial (C) fat-saturated fast spin-echo T1-weighted images of L3–L4 level of lumbar spine show strong enhancement of yellow ligaments (thin arrows) and of interspinal and supraspinal ligaments (thick arrows, B and C), corresponding to inflammatory involvement.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —55-year-old woman with spondyloarthropathy (precise diagnosis not yet established) and ligamentous inflammation. Gadolinium-enhanced sagittal (A), coronal (B), and axial (C) fat-saturated fast spin-echo T1-weighted images of L3–L4 level of lumbar spine show strong enhancement of yellow ligaments (thin arrows) and of interspinal and supraspinal ligaments (thick arrows, B and C), corresponding to inflammatory involvement.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —55-year-old woman with spondyloarthropathy (precise diagnosis not yet established) and ligamentous inflammation. Sagittal fat-saturated fast spin-echo T2-weighted image shows discrete hyperintensity of interspinal and supraspinal ligaments (arrows), less visible than with gadolinium-enhanced fat-saturated fast spin-echo T1-weighted sequences.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —45-year-old man with ankylosing spondylitis: postinflammatory fatty vertebral changes after Romanus spondylitis. Sagittal fast spin-echo T1-weighted image of thoracic spine shows circumscribed hyperintensity of anterior edges of vertebral endplates corresponding to fatty infiltration of bone marrow long after florid inflammatory Romanus spondylitis (arrows).

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —73-year-old woman with ankylosing spondylitis: postinflammatory vertebral sclerotic changes after Romanus spondylitis; ankylosis of zygapophyseal joints. Sagittal vertebral CT scan shows sclerotic change of anterior edge of vertebral endplates corresponding to postinflammatory Romanus involvement (arrows). Bone constructions and ankylosis of zygapophyseal joints (arrowhead) are also seen.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —80-year-old woman with ankylosing spondylitis: syndesmophytes. Sagittal (A) and coronal (B) CT scans of thoracic and lumbar spine show syndesmophytes corresponding to osseous bridge between two adjacent vertebrae (arrows).

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —80-year-old woman with ankylosing spondylitis: syndesmophytes. Sagittal (A) and coronal (B) CT scans of thoracic and lumbar spine show syndesmophytes corresponding to osseous bridge between two adjacent vertebrae (arrows).

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —21-year-old woman with spondyloarthropathy associated with Crohn's disease: unilateral sacroiliitis. Coronal STIR-weighted sequence of sacroiliac joints shows hyperintensity of right iliac subchondral bone marrow (arrowhead).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —54-year-old man with ankylosing spondylitis: bilateral sacroiliitis. Coronal STIR (A) and gadolinium-enhanced fat-saturated T1-weighted (B) images of sacroiliac joints show hyperintensity of subchondral bone marrow (arrows).

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —54-year-old man with ankylosing spondylitis: bilateral sacroiliitis. Coronal STIR (A) and gadolinium-enhanced fat-saturated T1-weighted (B) images of sacroiliac joints show hyperintensity of subchondral bone marrow (arrows).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —18-year-old man with ankylosing spondylitis: bilateral sacroiliitis. Gadolinium-enhanced coronal fat-saturated fast spin-echo T1-weighted image of sacroiliac joints shows enhancement of connective fibrous tissues (arrows). Hyperintensity of right iliac subchondral bone marrow (arrowhead) is also seen.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —18-year-old man with ankylosing spondylitis: bilateral sacroiliitis. Radiograph of sacroiliac joint failed to detect sacroiliitis.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —25-year-old man with ankylosing spondylitis: postinflammatory fatty infiltration after acute sacroiliitis. Coronal T1-weighted (A) and STIR-weighted (B) sequences show T1 hyperintensity and STIR hypointensity of subchondral bone marrow of right joint, finding indicative of fatty infiltration (arrows). STIR-weighted image shows no hyperintensity that would indicate active inflammatory involvement.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —25-year-old man with ankylosing spondylitis: postinflammatory fatty infiltration after acute sacroiliitis. Coronal T1-weighted (A) and STIR-weighted (B) sequences show T1 hyperintensity and STIR hypointensity of subchondral bone marrow of right joint, finding indicative of fatty infiltration (arrows). STIR-weighted image shows no hyperintensity that would indicate active inflammatory involvement.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —35-year-old woman with ankylosing spondylitis: postinflammatory sacroiliac sclerotic changes after acute sacroiliitis. Axial (A) and gadolinium-enhanced fat-saturated (B) T1-weighted images of sacroiliac joints show subchondral hypointensity indicative of sclerotic changes (arrows).

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —35-year-old woman with ankylosing spondylitis: postinflammatory sacroiliac sclerotic changes after acute sacroiliitis. Axial (A) and gadolinium-enhanced fat-saturated (B) T1-weighted images of sacroiliac joints show subchondral hypointensity indicative of sclerotic changes (arrows).

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —35-year-old woman with ankylosing spondylitis: postinflammatory sacroiliac sclerotic changes after acute sacroiliitis. Axial CT scan shows condensations of subchondral bone marrow of joints (arrows) predominant on left side.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A —53-year-old woman with ankylosing spondylitis: sacroiliac joint ankylosis. Axial CT scan (A) and volume reformation, frontal view (B) of sacroiliac joints show complete ankylosis with homogeneous osseous bridge passing through articulations (arrowheads).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B —53-year-old woman with ankylosing spondylitis: sacroiliac joint ankylosis. Axial CT scan (A) and volume reformation, frontal view (B) of sacroiliac joints show complete ankylosis with homogeneous osseous bridge passing through articulations (arrowheads).

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