REVIEW - Magnetic resonance imaging of the axial skeleton in rheumatoid disease

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Best Pract Res Clin Rheumatol. 2004 Dec;18(6):881-907.

Magnetic resonance imaging of the axial skeleton in rheumatoid disease.

Department of Radiology, Charite Campus Mitte, Humboldt-Universitat zu

Berlin, Schumannstr. 20/21, 10117 Berlin, Germany. kgh@...

The axial skeleton is a target for both spondyloarthritis and rheumatoid

arthritis. While conventional radiography allows the clear documentation of

the late stages of inflammatory changes, magnetic resonance imaging (MRI) is

sensitive enough to depict early inflammatory lesions. It is, therefore, of

particular importance for radiologists and clinicians to know the MRI

appearances of inflammatory changes of the axial skeleton in rheumatoid

diseases. Typical lesions in ankylosing spondylitis and related conditions

comprise spondylitis (Romanus lesion), spondylodiscitis (Andersson lesion),

arthritis of the apophyseal joints, the costovertebral and costotransverse

joints, and insufficiency fractures of the ankylosed vertebral spine

(non-inflammatory type of Andersson lesion). Sacroiliitis is associated with

chronic changes such as sclerosis, erosions, transarticular bone bridges,

periarticular accumulation of fatty tissue and ankylosis. In addition, acute

findings include capsulitis, juxta-articular osteitis and the enhancement of

the joint space after contrast medium administration. Another important sign

of spondyloarthritis is enthesitis, which affects the interspinal and

supraspinal ligaments of the vertebral spine and the interosseous ligaments

in the retroarticular space of the sacroiliac joints. The main site of

manifestation of spinal involvement in rheumatoid arthritis is the cervical

spine. Typical changes are the destruction of the atlantoaxial complex by

pannus tissue with subsequent atlantoaxial subluxation, basilar impression

and erosion of the dens axis. Changes in the lower segments of the cervical

spine are destruction of the apophyseal joints resulting in the so-called

stepladder phenomenon. Because of the uniform response of the discovertebral

complex to different noxae, a number of different conditions must be

distinguished on the basis of the patient's clinical findings and history in

combination with their imaging appearance. These conditions comprise

degenerative disc disease, septic spondylodiscitis, Scheuermann's disease,

Paget's disease and diffuse idiopathic skeletal hyperostosis (DISH).

PMID: 15501188

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=15501188

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