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Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging
  1. X Baraliakos1,
  2. R Landewé2,
  3. K-G Hermann3,
  4. J Listing4,
  5. W Golder5,
  6. J Brandt1,
  7. M Rudwaleit6,
  8. M Bollow7,
  9. J Sieper6,
  10. D van der Heijde2,
  11. J Braun1
  1. 1Rheumazentrum Ruhrgebiet, Herne, Germany
  2. 2Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, The Netherlands
  3. 3Department of Radiology, Charité Medical School, Berlin, Germany
  4. 4German Rheumatism Research Centre, Berlin, Germany
  5. 5Department of Radiology, DRK Kliniken Westend, Berlin, Germany
  6. 6Department of Rheumatology, Charité Medical School, Campus Benjamin Franklin, Berlin, Germany
  7. 7Department of Radiology, Augusta-Krankenanstalt, Bochum, Germany
  1. Correspondence to:
    Professor J Braun
    Rheumazentrum Ruhrgebiet, Landgrafenstr 15, 44652 Herne, Germany;


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 τ 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.

  • AS, ankylosing spondylitis
  • CS, cervical spine
  • Gd-DTPA, gadolinium-diethylenetriamine-pentaacetic acid
  • LS, lumbar spine
  • MRI, magnetic resonance imaging
  • STIR, short τ inversion recovery
  • TS, thoracic spine
  • VU, vertebral unit
  • ASspiMRI score
  • STIR magnetic resonance imaging
  • ankylosing spondylitis
  • inflammation
  • T1/Gd-DTPA magnetic resonance imaging
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