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Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging

X Baraliakos¹, R Landewé², K-G Hermann³, J Listing⁴, W Golder⁵, J Brandt¹, M Rudwaleit⁶, M Bollow⁷, J Sieper⁶, D van der Heijde², J Braun¹

¹ Rheumazentrum Ruhrgebiet, Herne, Germany
² Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, The Netherlands
³ Department of Radiology, Charité Medical School, Berlin, Germany
⁴ German Rheumatism Research Centre, Berlin, Germany
⁵ Department of Radiology, DRK Kliniken Westend, Berlin, Germany
⁶ Department of Rheumatology, Charité Medical School, Campus Benjamin Franklin, Berlin, Germany
⁷ Department of Radiology, Augusta-Krankenanstalt, Bochum, Germany

Correspondence to:
Professor J Braun
Rheumazentrum Ruhrgebiet, Landgrafenstr 15, 44652 Herne, Germany; j.braun{at}rheumazentrum-ruhrgebiet.de

Background: Magnetic resonance imaging (MRI) is increasingly used to detect inflammation in the spine of patients with ankylosing spondylitis (AS).

Objectives: To detect differentially the presence and extent of inflammation in the three spinal segments of patients with AS by MRI.

Methods: In 38 patients with active AS, acute spinal lesions were assessed by T₁ weighted, gadolinium enhanced, spin echo MRI (T₁/Gd-DTPA) and short inversion recovery (STIR) sequences. MRI was quantified by the validated scoring system ASspiMRI-a. Acute spinal lesions were detected in the whole spine and in each spinal segment. One vertebral unit (VU) was defined as the region between two virtual lines drawn through the middle of each vertebral body.

Results: A greater number of inflammatory spinal lesions were found by the STIR sequence than by Gd-DTPA: inflammation was present in 30.6% of the VUs as assessed by STIR, compared with 26.8% of the same VUs assessed by T₁/Gd-DTPA. Inflammation was found more commonly in the thoracic spine (TS) than in the cervical (CS) or the lumbar spine (LS) with both techniques. When STIR was used, spinal inflammation in the CS, the TS, and LS was detected in 10/38 (26%), 28/38 (74%), and 9/38 (24%) patients, respectively. The VU T7/8 was found to be the VU most often affected by both techniques (27.8% by T₁/Gd-DTPA and 34.5% by STIR).

Conclusions: Spinal inflammation is a common manifestation in patients with AS, and appears more frequently in the TS. The scoring system ASspiMRI-a can be used for evaluation of acute spinal changes in AS.

Abbreviations: AS, ankylosing spondylitis; CS, cervical spine; Gd-DTPA, gadolinium-diethylenetriamine-pentaacetic acid; LS, lumbar spine; MRI, magnetic resonance imaging; STIR, short inversion recovery; TS, thoracic spine; VU, vertebral unit

Keywords: ASspiMRI score; STIR magnetic resonance imaging; ankylosing spondylitis; inflammation; T1/Gd-DTPA magnetic resonance imaging

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