We reviewed patients’ clinical information and radiographic studies. Consultation with the other authors was done when there was any disagreement in diagnosis or structure of involvement. and M.M.-H.T.) reviewed these cases separately at first, and then discussed them together. Routinely, we perform coronal and sagittal 1-mm reformat and 3D surface reconstruction. 3D-CT had been performed by using a multidetector-row CT unit based on 0.6–1-mm axial images. CT scans had been performed with 4-mm contiguous sections. Contrast-enhanced T1-weighted images with fat saturation in sagittal and axial views had been obtained in 4 cases. Fat saturation T2-weighted imaging was not performed. Spatial saturation had been applied anteriorly and posteriorly on T2-weighted images to remove artifacts from heart, great vessel and posterior fat signals. MR imaging of the spine had been done by using a 1.5-T unit, including the following pulse sequences: sagittal T1-weighted, fast spin-echo T2-weighted, axial T1-weighted, and axial T2-weighted images. Conventional radiographs were available for all patients, CT scans were available for 7 4 of them had 3D reconstructed CT scans (3D-CT). They included 9 men and 3 women, ranging in age from 41 to 90 years (mean, 58 years). Twelve consecutive AS patients with spinal fracture were identified from our records of MR images on the basis of their histories and imaging evidence obtained from May 2001 to November 2003. Our goal was to characterize spinal fractures in AS, and determine the value of various types of imaging studies. The most serious complication of the disease is spinal fracture, which can occur with even minor trauma because of the rigidity and osteoporotic involvement of the spine ( 3, 5, 6). Patients with AS tend to present with restricted spinal movement and progressive deformity ( 4). Syndesmophytes form by means of continuing enchondral ossification until they ultimately bridge the adjacent vertebral bodies with progression to a bamboo spine ( 3). In the spine, the disease is characterized by ossification of the spinal ligaments, joints, and disks. Radiographically, the earliest manifestation of AS is sacroiliitis, followed by spinal involvement. The human leukocyte antigen HLA-B27 gene is present in approximately 90% of patients, compared with a prevalence of 1–3/1000 in the general population ( 1, 2). With the capability to show lesions in the posterior column, MR imaging can serve to evaluate AS patients with spinal fracture for the possibility of 3-column involvement.Īnkylosing spondylitis (AS), or Marie-Strümpell disease, is an inflammatory disorder of unknown cause that primarily affects the axial skeleton. MR imaging also showed avascular necrosis and occult fractures better than conventional radiographs or CT scans.ĬONCLUSIONS: MR imaging shows abnormalities in AS that may not be clear or even detectable by using other imaging methods. MR imaging depicted these following findings that usually were not shown on conventional radiographs or 3D-CT scans: cord deformity, soft tissue disruption, and ligament tears in the posterior column. The sensitivities of 3D-CT scans for demonstration of the following problems were similar to that of MR imaging and were better than that of conventional radiographs: tearing of the posterior longitudinal ligament, the thoracic spinous process fracture, and the facet fracture. A routine 4-mm axial CT was not enough to demonstrate all fractures and ligament tears. The 3 columns of the spine were involved in 11 patients. RESULTS: Fractures were found in the cervical spine in 3 patients and in the thoracolumbar spine in 9. We carefully reviewed clinical histories and imaging presentations. Conventional radiographs were available for 12, CT scans for 7, and 3D-CT scans for 4. METHODS: Twelve successive cases of spinal fractures were identified in MR imaging files of AS patients. The purpose of our investigation was to characterize spinal fractures and determine the value of different imaging modalities in AS. BACKGROUND AND PURPOSE: Spinal fractures in ankylosing spondylitis (AS) were difficult to diagnose before CT and MR imaging were available.
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