Extensive spine tenderness, 2 year duration of inflammatory back pain.

• Multiplanar imaging sequences acquired as per spondyloarthropathy protocol: Sagittal T1, STIR whole spine and Coronal T1, STIR sacroiliac joints
• No prior study for correlation.
• Sacroiliac joint spaces are maintained, no joint effusion, no subchondral bone marrow edema, no post inflammatory fat accentuation nor erosive disease identified. Minimal cortical irregularity anteriorly. No features to suggest capsulitis. Normal signal intensity entheseal compartment.
• Vertebral body height, alignment is normal. Normal vertebral marrow signal intensity with no focal osteitis. No postinflammatory fat accentuation lesions. No syndesmophyte formation. Posterior paraspinal soft tissues are normal. No facet joint effusions.
• No significant disc disease identified. Spinal cord ends at the upper border of T12. Normal craniocervical junction.

Essentially normal study as described. Correlation with HLA-B27, inflammatory markers.

Clinical Indication: History of right sacroiliac joint infection and periarticular abscess 18 months previous, successfully treated. Lower inflammatory back pain, ? underlying SpA versus symptoms related to prior infection.

Comparison

Comparison is made with the series of MR examinations of the spine and sacroiliac joints and bone scan 18 months previously, prior study demonstrated right paraspinal abscess with secondary right sacroiliac joint infection.

Sacroiliac Joints

Right-sided erosions at the sacroiliac joint with associated subchondral sclerosis, widening of the joint space, and a small joint effusion. There is no bony ankylosis and the left sacroiliac joint is normal in appearance. Appearances are in keeping with prior infection. No residual soft tissue or epidural collection is demonstrated. Please note that dedicated axial images have not been performed and the paraspinal muscles have not been fully assessed.

Spine

No structural or inflammatory changes within the examined spine to suggest a diagnosis of seronegative spondyloarthropathy. There is reversal of the normal cervical lordosis with moderate disc osteophyte complexes of the mid and lower cervical spine that indent the anterior thecal sac. There is no myelomalacia demonstrated. If there is clinical concern a dedicated MR of the cervical spine is advised for full assessment.

There is a focus of intermediate T1 and increased T2 signal intensity within the right L1 transverse process that is felt likely to represent an incidental hemangioma.

The cord is normal in appearance and terminates at L1. The cauda equina is unremarkable and the craniocervical junction is normal in appearance.

Right sacroiliac joint post-infective sacroillitis as described. No MR evidence to support a diagnosis of a seronegative spondyloarthropathy.

Moderate disc osteophyte complexes of the mid and lower cervical spine as described requiring clinical correlation.

Inflammatory back pain, HLA B27 positive

Sacroiliac Joints

• The sacroiliac joints demonstrate subchondral sclerosis involving the iliac aspect and post inflammatory changes on the sacral aspect of both joints.
• There is no active osteitis. Joint spaces are maintained. There is no joint effusion or erosive disease.
• No enthesitis

Spine

• 7 cervical, 12 thoracic and 5 lumbar vertebrae.
• Normal vertebral height and alignment. No osteitis or PIFA, enthesitis or facet joint effusion.
• Maintained intervertebral disc space height and signal. Normal spinal canal

• Changes in keeping with low grade chronic sacroillitis given the provided clinical history.
• A followup MRI examination 1 year later demonstrated acute on chronic sacroillitis

29 m, Six-year inflammatory history back pain, limited range of motion cervical and lumbar spine. No response to non-steroidals. Very symptomatic.

No prior imaging for correlation.

Sacroiliac joints

• Bilateral partial fusion , greater than 50%.
• Residual joint space is markedly narrowed with cortical irregularity and evidence of prior erosive disease.
• There is extensive postinflammatory fat accentuation noted with minimal subchondral bone marrow edema.

Spine

• Extensive osteitis identified throughout the thoracic and lumber spine with multilevel involvement of both the anterior and posterior corners.
• Extensive involvement of the costotransverse articulations bilaterally with active osteitis.
• Active osteitis at both sternoclavicular joints.
• Early syndesmophyte formation within the upper midthoracic vertebrae, T2/3, T3/4 and T4/T5.
• Squaring of vertebral bodies noted.
• Biconcave compression fractures of T8, grade 1, T11, T12 and superior endplate T9 and L2 compression fractures.
• This likely relates to osteoporosis and baseline osteoporotic assessment is advised.
• Incidental hemangioma within C4.
• Normal craniovertebral junction. No significant disc disease. Spinal cord ends lower border T12.

• Acute on chronic spondyloarthropathy.
• Vertebral compression fractures, Osteoporotic assessment advised

Psoriatic arthritis, low back pain, ?SpA

No prior imaging for correlation.

Spine

• Bilateral spondylolysis L5 with anterolisthesis of L5 on S1 measuring 7.1 mm, grade 1.
• Uncovered disc extends into both neural foramina with secondary bilateral mild foraminal stenosis and abutment of the exiting nerve roots more pronounced on the left.
• There is related perifacet soft tissue edema at L4-L5 and L5-S1.
• There is a mild to moderate diffuse disc bulge L3-L4, disc extends to thecal sac and into the inferior aspect of the right neuroforaminal but without impingement of exiting right nerve root.
• Mild to moderate diffuse discophyte at C6-C7 with narrowing of the anterior CSF column.
• Cord appears to maintain normal signal intensity. No syrinx formation.
• Normal craniovertebral junction.
• Current study was not dedicated for assessment of disc disease and if clinically indicated this could be further evaluated with dedicated imaging.
• Otherwise normal vertebral body height, alignment. No other evidence of focal osteitis, no post inflammatory fat accentuation lesions identified.
• Spinal cord ends lower border T12.

Sacroiliac Joints

Joint spaces are maintained, no joint effusion, erosions, subchondral bone marrow edema or post inflammatory fat accentuation.

• No imaging evidence of spondyloarthropathy.
• Anterolisthesis L5 on S1 secondary to bilateral spondylolysis L5 with bilateral foraminal stenosis.
• Degenerative disc disease at L3-L4 and at C6-C7 as described.
• If clinically indicated this could be further evaluated with dedicated imaging.
• Clinical correlation.

Worsening low back pains w/ stiffness, previous MRI suspicious of spondyloarthropathy (not available)

• Six lumbar type vertebrae with lumbarization of S1.
• Normal vertebral body height, alignment. There is increasing thoracic kyphosis. Squaring lower thoracic vertebrae. Extensive anterior corner postinflammatory fat accentuation throughout the thoracic and lumbar spine.
• Significant active osteitis within the mid and lower thoracic spine extending inferiorly from T5 through to T12. There is involvement of both the anterior and posterior corners. Osteitis costotransverse joints T6 through T10. Mild osteitis within the lumbar spine most pronounced within L4.
• Multilevel syndesmophyte formation
• No significant disc disease. Normal craniovertebral junction. Spinal cord ends lower border mid-L1.
• Sacroiliac joint spaces are narrowed bilaterally with mild cortical irregularity. There is evidence of early bone fusion bilaterally more pronounced on the left. Fusion right transverse process at L5 with superior right sacrum, ilium. Bilateral postinflammatory fat accentuation.

Features in keeping with ankylosing spondylitis with acute and chronic sacroiliitis and extensive acute on chronic changes within the thoracic and lumbar spine as described.

• Elite gymnast, low back pain on extension, dysfunction right fifth facet joint, radiographs negative, ? Occult fracture or facet injury of the lower lumbar spine or sacrum.
• No prior study for correlation.

• Multiplanar imaging sequences acquired as per lumbar spine and sacrum.
• Presuming 5 lumbar type vertebrae the lumbar vertebrae are numbered on sagittal series 2 image 8 (not on provided images).
• There is a transitional L5 vertebrae.
• Bilateral enlarged transverse processes L5 articulate with the superior margin of the sacrum and ilium more pronounced on the right side.
• There is related cortical irregularity along the superior margin of the sacrum and undersurface of transverse process with subchondral post inflammatory fat accentuation.
• No related bone marrow edema at the articulation.
• No corresponding changes noted with the left transverse process which articulates with the superior left sacrum.
• The sacroiliac joints are normal.
• Normal sacral neural foramina.
• Vestigial disc at S1-2.
• Normal vertebral body height and alignment.
• No evidence of a spondylolysis or spondylolisthesis.
• Normal vertebral marrow signal intensity.
• Spinal cord ends mid T12.
• L2-L3 minimal diffuse disc bulge, normal spinal canal, thecal sac, neural foramina, exiting nerve roots, lateral recesses and facet joints. No evidence of neural abutment or impingement.
• L3-L4 minimal diffuse disc bulge, normal spinal canal, thecal sac, neural foramina, exiting nerve roots, lateral recesses and facet joints. No evidence of neural abutment or impingement.
• L4-L5 mild diffuse disc bulge extending to and with minimal indentation thecal sac. Normal neural foramina,exiting nerve roots, lateral recesses and facet joints.
• L5-S1normal spinal canal, thecal sac, neural foramina, exiting nerve roots, lateral recesses.
• Minimal left facet joint effusion with small synovial cyst extending posteriorly.
• Mild sclerosis within the left L5 pars. No spondylolysis.
• This is likely stress-related given the transitional L5 vertebrae.
• No evidence of neural abutment or impingement.

• No stress fracture.
• Transitional L5 vertebrae.
• Articulation bilaterally with sacrum more pronounced on the right with right sided related cortical and subchondral changes as described.
• This is the likely etiology site of the patient's symptoms (Bertolotti syndrome).
• There is minimal related left facet joint changes L5-S1 and sclerosis without fracture left L5 pars.
• Minimal diffuse disc bulges as described.

New weakness/numbness bilateral legs. Rule out spinal canal stenosis. History prostate cancer.

• Multiplanar multisequence MR images of the spine were.
• Axial images were obtained through the lower thoracic spine.
• There is diffuse loss of normal marrow signal intensity with heterogenous low signal intensity replacement on both T1 and T2 weighted sequences.
• Features are in keeping with diffuse metastatic sclerotic disease involving the entirety of the visualized bony structures and all vertebral levels.
• An epidural soft tissue mass is present at the T9-10 level measuring approximately 4 cm in greatest length.
• This lesion eccentrically surrounds the cord from the 7 to 4 o'clock position with preservation of the midline attachment of the posterior longitudinal ligament (curtain sign).
• This lesion causes moderate to severe compression of the cord compressing the cross sectional area of the cord to 19 square mm (series 7, image 11) at the narrowest point.
• For reference, the normal cross-sectional area of the cord just above this stenosis measures approximately 53 square mm (series 7, image 3).
• There are areas of loss of the normal posterior cortex signal compatible with tumoral breakthrough through the cortex.
• The cord signal at the level of the epidural tumor is normal.
• Additionally, there is slightly asymmetrical soft tissue prominence along the posterior body of the L4 vertebrae and to a lesser degree at the L3 level, measuring several millimeters in maximal diameter.
• The vertebral body heights and disc heights are maintained.
• There is no significant disc bulging.

1. Diffuse metastatic disease is seen throughout the bony structures of the visualized spine in keeping with metastatic prostatic cancer.
2. Metastatic soft tissue mass is present extending along the posterior T9 and T10 vertebrae.

Know AS,? Active disease.

No prior imaging for correlation.

Spine

• Normal vertebral body height, alignment.
• No significant disc disease.
• Normal craniovertebral junction.
• Spinal cord ends mid T12
• There is multilevel antero-superior and inferior corner post inflammatory fat accentuation lesions.
• Features are most pronounced in the lower thoracic and lumbar spine.
• No active osteitis of the anterior or posterior elements.
• No significant facet joint effusions.
• No enthesitis.

Sacroiliac Joints

• Sacroiliac joint spaces are maintained.
• No significant joint effusion.
• There is bilateral symmetrical erosive disease most pronounced on the iliac aspect.
• Significant subchondral post inflammatory fat accentuation is present.
• No significant active osteitis.
• There is minimal left iliac subchondral bone marrow edema present.

• Features in keeping with patients known chronic Ankylosing Spondylitis with bilateral chronic symmetrical sacroiliitis and chronic spondylitis.
• No significant active disease identified.

Pelvic and SIJ stiffness, inflammatory symptoms. Some mechanical components. ?SpA

Spine

• Alignment of the spine is normal.
• The spinal cord demonstrates normal morphology and signal.
• No significant disc degenerative change.
• Bone marrow signal is within normal limits.
• At the T11-T12 level, small foci of anterior corner bone marrow osteitis.

Sacroiliac Joints

• There is moderate to marked extensive subchondral bone marrow edema in the right sacroiliac joint.
• There is more focal moderate to severe subchondral bone marrow edema in the inferior aspect of the left SI joint.
• here are small bilateral erosions of the sacroiliac joints bilaterally, left more than right. This is associated with iliac sided subchondral sclerosis.
• There is no significant subchondral PIFA.

Impression

Bilateral acute on chronic sacroiliitis with mild lower thoracic anterior corner osteitis.