ankylosing spondylitis cervical spine x ray

#Ankylosing spondylitis cervical spine x ray free

In daily practice, the combination of STIR and T1-weighted sequences is usually sufficient, and they are complementary therefore, concurrent viewing by scrolling simultaneously through synchronized images of both of these sequences is needed.

#Ankylosing spondylitis cervical spine x ray free

The T1-images are better for evaluating chronic structural changes, while the STIR sequences suppress fat signals and bring out signals from free water present in bone marrow edema (BME) in active axSpA. Please note that cortical bone has dark appearance on both T1 and STIR images. T1-weighted spin echo (T1SE) and T2-weighted short tau inversion–recovery (STIR) MRI sequence of the SIJs are showing bilateral sacroiliitis in Figure 10- 7. If the diagnosis of AS/axSpA cannot be established based on clinical features and conventional radiography, but it is still clinically suspected, MRI of the SIJs is recommended. Complete fusion of the SIJs and the whole vertebral column in a patient with severe, long-standing and very advanced AS are shown in Figure 10- 6.

Syndesmophytes develop from the vertebral corners along superficial layers of annulus fibrosis, extend vertically toward the adjacent vertebral corner, and can ultimately bridge the adjacent vertebral corners, leading to ankylosis (“bamboo spine”) that can ultimately include the cervical spine ( Figure 10- 5). Erosions of the vertebral corners and squaring of vertebral bodies can also be seen, along with sclerosis of vertebral corners that led to the appearance of “shiny corners.” Follow-up radiographs, if needed, should only be performed after more than 2 years due to the associated radiation. In patients with AS (not non-radiographic axial spondyloarthritis (nr-axSpA)), an initial conventional radiography of the spine (lumbo-thoracic and cervical) may be needed to detect syndesmophytes (which are predictive of development of further syndesmophytes) for long-term monitoring of structural damage and response to treatment over time. Inclusion of MRI in the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA has helped in early recognition of the disease. Therefore, pelvic radiographs of such women may show iliac sclerosis adjacent to the joint that is termed “osteitis condensans ilii,” and it should not be confused with sacroiliitis ( Figure 10- 4).Ĭonventional radiography only visualizes the late structural consequences of the inflammatory process, while the early inflammatory changes can be detected by magnetic resonance imaging (MRI), often several years before the appearance of sacroiliitis on radiography. For example, the SIJs can become painful during pregnancy or postpartum as they widen and develop increased mechanical stress during pregnancy and childbirth. There are several disorders can cause sacroiliitis-like changes of the SIJs, such as diffuse idiopathic skeletal hyperostosis (DISH) ( Table 10- 2), osteoarthritis, hyperparathyroidism and many others detailed on the website. Oblique views of the SIJs are not advised due to excessive gonadal radiation, whereas posteroanterior (PA) and properly performed Ferguson (angled) views ( Figure 10- 2) can be useful, although usually not needed. It is not surprising that performance of radiologists and rheumatologists in detecting sacroiliitis on pelvic X-ray has shown only moderate sensitivity (84.3%/79.8%) and specificity (70.6%/74.7%) and it could not be improved by workshops and by individual training. But the SIJ has several unique anatomic features with variations in the general population that make it difficult to profile it well on the conventional pelvic anteroposterior (AP) radiograph, which is the first step to look for sacroiliitis ( Figures 10- 1 to 10- 3). Radiographically, it is graded on a scale ranging from 0 (no abnormalities) to 4 (complete fusion or ankylosis of the SIJ) ( Table 10- 1). The sacroiliitis is usually bilateral and symmetrical in patients with primary AS (unassociated with psoriasis or inflammatory bowel disease (IBD)) and typically first involves the lower ventral (synovial) part of the sacroiliac joints (SIJs).

Imaging is almost a necessary element in the diagnostic process of ankylosing spondylitis/ axial spondyloarthritis (AS/axSpA) because many of its clinical features lack specificity, and radiographic evidence of sacroiliitis is a key component of the classification criteria.