Article Text

This article has a correction. Please see:

other Versions

PDF
The Fatty Romanus Lesion - A non-inflammatory spinal MRI lesion specific for axial-Spondyloarthropathy
  1. Alexander N Bennett (alexander.n.bennett{at}btinternet.com)
  1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
    1. Amer Rehman (rehman.amer{at}gmail.com)
    1. Department of Medical Imaging, American Hospital Dubai, United Arab Emirates
      1. Elizabeth M.A. Hensor (e.m.a.hensor{at}leeds.ac.uk)
      1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
        1. Helena Marzo-Ortega (medhmo{at}leeds.ac.uk)
        1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
          1. Paul Emery (p.emery{at}leeds.ac.uk)
          1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom
            1. Dennis G McGonagle (d.g.mcgonagle{at}leeds.ac.uk)
            1. Academic Section of Musculoskeletal Disease, University of Leeds, United Kingdom

              Abstract

              Objective: Fatty changes at vertebral corners have been reported on MRI in ankylsoing spondylitis but the distribution or specificity of these lesions to axial-SpA has not been determined. This study assessed the diagnostic utility of Fatty Romanus Lesions (FRLs) for axial-SpA in a chronic back pain population.

              Methods: Axial-skeleton TI SE and fat-suppressed MRI were performed on 174-patients with back pain and 11-controls. MRI lesions including FRLs were scored blind. An imaging diagnosis was given on MRI findings alone and compared to the gold-standard treating physician diagnosis.

              Results: Twenty-nine patients had FRLs. Thirty-one percent(20/64) of SpA, 13%(6/45) of degenerative arthritis, 4%(2/45) of spinal malignancy, 5%(1/20) of "other" diagnoses and 0/11 normals. The majority of FRLs in SpA 59%(135/226) were present in the thoracic-spine. The diagnostic utility of FRLs for SpA(LR=4.7) was significantly(p<0.05) greater than for other diagnoses and increased further(LR=12.6,p<0.05) when >5 FRLs were present. Of note 5/20(25%), of SpA patients with FRLs had no diagnostic bone-oedema lesions on fat-suppressed MRI suggesting that FRLs may be useful diagnostically in axial-SpA.

              Conclusion: This study defines the FRL as a diagnostic imaging feature of axial-SpA which may be useful where inflammatory changes are absent on fat-suppression MRI and where radiography is normal.

              Statistics from Altmetric.com

              Request permissions

              If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

              Linked Articles

              • Miscellaneous
                BMJ Publishing Group Ltd and European League Against Rheumatism