Document Detail

Magnetic resonance imaging of the axial skeleton in rheumatoid disease.
MedLine Citation:
PMID:  15501188     Owner:  NLM     Status:  MEDLINE    
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).
Kay-Geert A Hermann; Matthias Bollow
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Best practice & research. Clinical rheumatology     Volume:  18     ISSN:  1521-6942     ISO Abbreviation:  Best Pract Res Clin Rheumatol     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-10-25     Completed Date:  2005-02-03     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  101121149     Medline TA:  Best Pract Res Clin Rheumatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  881-907     Citation Subset:  IM    
Department of Radiology, Charité Campus Mitte, Humboldt-Universität zu Berlin, Schumannstr. 20/21, 10117 Berlin, Germany.
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MeSH Terms
Magnetic Resonance Imaging / methods*
Rheumatology / methods
Spine / pathology*
Spondylitis, Ankylosing / diagnosis*

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