Corner Lesions Research Articles

The Usefulness of Posterior Shiny Corner Lesions in the Early Diagnosis of Medial Meniscus Posterior Root Tears.

Posterior shiny corner lesions (PSCLs) have been reported to be useful for the early diagnosis of medial meniscus posterior root tears (MMPRTs) in surgical patients. However, the usefulness of PSCLs in outpatients, particularly regarding the optimal timing of magnetic resonance imaging (MRI) examinations after injury, remains unknown. We hypothesized that PSCLs would normally be observed in patients with MMPRTs within one month of injury. This study included 144 patients with knee pain who visited our hospital between January 2021 and May 2023. MRI findings within and after one month were examined. Fisher's exact test was performed for PSCLs, cleft signs, ghost signs, radial tear signs, bone cysts, and medial meniscus extrusion (MME), which are findings used for the diagnosis of MMPRTs. Time-dependent receiver operating characteristic (ROC) curve analysis was performed for each MRI finding. A binomial logistic regression analysis was performed for age, sex, PSCL, ghost sign, and MME. PSCLs were observed on 82.6% of the MRI scans within one month, but the positivity rate decreased after one month. After one month, a high percentage of patients had cleft signs and ghost signs. The results of a time-dependent ROC curve analysis showed that the PSCL had better diagnostic ability than the cleft sign, ghost sign, radial tear sign, and MME at a relatively early stage. Additionally, the area under the curve (AUC) of PSCL peaks around 35 days and then declines, reaching 0.8 or less around 40 days. On the other hand, the AUC of the cleft sign and ghost sign began to increase around 30 days after injury, and it exceeded 0.8 after approximately 100 days. The results of the binomial logistic regression analysis revealed significant PSCLs and ghost signs. Independent associations between the PSCL, or ghost sign, and the MMPRT were demonstrated. This study suggests that PSCLs have a superior diagnostic capability for MMPRT during the early stages of injury compared with other MRI findings in outpatients. In particular, PSCLs have a high positivity rate within one month after injury and a high diagnostic capacity up to 40 days after injury.

MRI Workshop for Axial Spondyloarthritis 2023 Interpretation of MRI Spine

Magnetic resonance imaging (MRI) of the spine is a frequent investigation for low back pain (LBP). Applications in axial spondyloarthritis (SpA) include diagnosis and assessment of disease activity. Sacroiliitis on MRI is a known diagnostic criterion. Other MRI lesions such as corner inflammatory lesions (CIL) and fatty corner lesions (FCL) may have potential roles in aiding diagnosis 1 , 2 and in predicting the formation of syndesmophytes. Facet joint and costovertebral lesions are associated with limited spinal mobility and functional impairment 3 . Other lesions described include discovertebral lesions (DVL), Modic type I and II lesions. Identification of individual lesions helps rheumatologists to understand disease progression and guide treatment.

Racehorse welfare across a training season.

Racehorse welfare is gaining increasing public attention, however scientific evidence in this area is lacking. In order to develop a better understanding of racehorse welfare, it must be measured and monitored. This is the first study to assess racehorse welfare using scientific objective methods across a training season. The aim of this study was threefold, firstly to investigate welfare measures which could be used in the first welfare assessment protocol for racehorses. Secondly, to understand the effect that a racing and training season had on individual racehorses and thirdly to identify risk factors for both good and poor welfare. Thirteen racehorse training yards were visited at the beginning and the peak of the racing season in England. Behavioral observations along with individual environmental and animal-based welfare measures were carried out on 353 horses in 13 training yards selected for variability. In our sample the horses were generally in good physical health: 94% of horses recorded as an ideal body condition score, no horses had signs of hoof neglect and 77.7% had no nasal discharge. The overall prevalence of external Mouth Corner Lesions was 12.9% and was significantly higher for Flat racing than Jump racing horses. The majority of horses (67.5%) showed positive horse human interactions. When stabled 54.1% horses had physical social contact and nasal discharge was not associated with increased physical contact. The training season significantly affected Human Reactivity Tests, Horse Grimace Scale scores and time spent resting and feeding. A total of 14.5% of horses displayed stereotypic behavior on at least two occasions. Horses with windows in their stables spent more time surveying their surroundings. Overall, in this population of racehorses, horses spent around a third of their daytime feeding (33.7%) followed by time spent standing resting (22.6%). The welfare assessment protocol used in this study is suitable for use in industry to collect welfare data on racehorses.

Relationship between sex and clinical and imaging features of early axial spondyloarthritis: results from a 48 month follow-up (Italian arm of the SPondyloArthritis Caught Early (SPACE) study)

Objectives To assess the association between sex and clinical and disease activity indices, and X-rays and magnetic resonance imaging (MRI) features, in early-stage axial spondyloarthritis (axSpA). Method Baseline data analysis was conducted on the Italian SPACE cohort, including patients with chronic back pain (duration ≥ 3 months and ≤ 2 years; onset < 45 years). Patients underwent MRI and X-rays of the sacroiliac joints (SIJs) to establish the diagnosis of axSpA, according to Assessment of SpondyloArthritis international Society criteria and physician’s judgement. Clinical features, disease activity and functional indices, and images were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRI images were scored by two readers following Spondyloarthritis Research Consortium of Canada (SPARCC), modified Stoke Ankylosing Spondylitis Spinal Score, and modified New York criteria. Characteristics of axSpA patients according to sex (male/female) were compared over time using descriptive statistics. Results Ninety-one patients had axSpA (83.5% non-radiographic; 16.5% radiographic); 47.3% were male. Males were younger, with shorter duration of axial symptoms, and more frequently had HLA-B27 positivity, radiographic sacroiliitis with a bilateral/symmetric pattern, and more signs of spondylitis. Females more frequently showed peripheral/entheseal involvement and the non-radiographic phenotype. Males showed increased pelvic/spinal radiographic progression and more often had active sacroiliitis on MRI. Although the frequency of inflammatory corner lesions did not differ between males and females, localization varied, with more cervical/thoracic MRI-spine lesions in females and more lumbar lesions in males. We observed a significant downward trend of SPARCC SIJ/spine scores in all patients, irrespective of sex. More fat lesions were observed on MRI-spine in females and on MRI-SIJ in males. Conclusion Sex was associated with distinct axSpA features: females showed low-grade radiographic sacroiliitis and spinal progression, and a higher prevalence of cervical and thoracic spine MRI signs.

Articular Regional Reconstruction (ARR) for Large Osteochondral Lesions of the Talus using Viable Osteochondral Allograft Combined with Autograft: Technique Description and Case Series

Category: Ankle; Sports; Trauma Introduction/Purpose: Symptomatic osteochondral lesions of the talus (OLT) are challenging to treat, and large lesions (&gt;10mm) with concomitant subchondral bony defects are particularly challenging. Standard treatments such as bone stimulation are limited and are often restricted to smaller lesions. Particulate and fragmented chondral allograft techniques face limitations with uncontained lesions. Structural allograft/autograft techniques often require removal of regions of native, uninjured bone and may encounter donor issues. Postoperatively, ensuring reliable osseous and cartilaginous healing responses can be difficult. Articular Regional Reconstruction (ARR) is a novel technique combining viable osteochondral allograft with morselized autograft bone to address large OLT lesions with bony defects, whether contained or uncontained. We describe a consecutive series of patients undergoing ARR here. Methods: Patients indicated for the ARR procedure had preoperative MRI and CT imaging identifying large (&gt;10mm), unstable osteochondral lesions with bony defects; 11 consecutive patients that had undergone ARR were identified. OLT lesions were initially inspected arthroscopically, and then converted to open debridement. Medial malleolar osteotomies were used for access when necessary. A stable bony base and viable cartilage rim was established, removing all damaged cartilage and nonstructural material from the OLT and bony defect. Talar body structure and morphology was restored using iliac crest or tibial morselized autograft bone placed in the bony defect. Viable osteochondral allograft (Cartiform) was shaped and then secured over the autograft using suture anchors placed at the lesion periphery. Patient Reported Outcome (PRO) measures included PROMIS- physical function (PROMIS-PF), PROMIS-pain interference (PROMIS-PI), and single assessment numeric evaluation (SANE). Three patients without PRO data were excluded, leaving eight patients with preoperative and postoperative PRO data for analysis. Results: The ARR patients averaged 40 years old (range 28-60) with a mean follow up of 19 months (range 10-38). The lesion surface areas averaged 1.95 cm2 (range 1.17-2.99 cm2) with a depth of 7.25mm (range 5-9mm). Four were uncontained corner lesions. Postoperative PROMIS-PF improved from 41 to 47 (p = 0.036), and PROMIS- PI improved from 60 to 53 (p = 0.093). Average SANE scores improved from 60 to 69 (p = 0.148). No complications occurred. No revision OLT surgeries were required, though three patients returned to the OR (Two for osteotomy screw removal, one for anterior impingement of opposite corner). During these 'second looks', the implanted cartilage layer was found intact. In a recent survey, all patients indicated they would undergo the procedure again. Conclusion: Articular Regional Reconstruction (ARR) is a reproducible procedure with demonstrated potential for improvement in pain and physical function among patients with symptomatic, large osteochondral lesions of the talus with bony defects, whether 'contained' or 'uncontained'. It has particular utility as an alternative to bulk structural graft salvage procedures among patients who have failed prior procedures, as 5 of the 8 patients had undergone unsuccessful prior surgical intervention for their OLT by outside providers. Further studies on ARR of the talus are necessary to elucidate the prognosis of this procedure, establish indication boundaries, and strengthen long-term outcome data.

MRI lesions in SpA: a comparison with noninflammatory back pain using propensity score adjustment method.

Background:Magnetic resonance imaging (MRI) is important in the management of axial spondyloarthritis (SpA). However, many MRI lesions are not exclusive to axial SpA. Further characterization of these lesions may lead to better clinical decisions.Objective:The objective of this study was to compare the frequency of individual spinal MRI lesions between axial SpA and noninflammatory back pain. The factors associated with individual lesions in participants with axial SpA were also determined.Design:This was a cross-sectional observational study.Methods:MRI lesions in 447 participants with axial SpA and 122 participants with noninflammatory back pain were compared using the propensity score adjustment method. Individual lesions included discovertebral lesions (DVL), Modic type 1 lesions, DVL without Modic type 1 lesions, facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL). The factors associated with the lesions were determined using regression analyses.Results:Among participants with axial SpA, 81.9% were HLA-B27-positive, 55.0% had radiographic axial SpA, and 60.5% had radiographic features of spinal damage (mSASSS >2). Almost half (48.6% in axial SpA versus 31.1% in noninflammatory back pain) had inflammatory lesions on spinal MRI. In propensity score matching with noninflammatory back pain, axial SpA had an increased occurrence of DVL without Modic type 1 lesion (OR = 3.43, p = 0.01), costovertebral lesion (OR = 11.89, p = 0.02), number of CIL (B = 1.19, p < 0.001), and number of FCL (B = 3.33, p < 0.001). Similar associations were found in the regression models in the radiographic axial SpA subgroup: DVL without Modic type 1 lesion (OR = 2.46, p = 0.001), costovertebral lesion (OR = 3.86, p < 0.001), number of CIL (B = 1.13, p < 0.001), and FCL (B = 2.29, p < 0.01).Conclusion:MRI lesions including DVL without Modic type 1, costovertebral joint lesions, CIL, and FCL were more specific in axial SpA.

Psoriasis and imaging progression in early axial spondyloarthritis: results from a 48-month follow-up (Italian arm of SPACE study).

To assess the influence of psoriasis on spinal/pelvic radiographic progression and MRI features in early-stage axial spondyloarthritis (axSpA). Analysis of baseline data from the Italian SPACE cohort, including patients with chronic back pain (CBP; duration ≥3 months and ≤2 years; onset <45 years) was performed. Patients underwent a diagnostic work-up, including MRI and X-rays of the sacroiliac joints (SIJ), to establish diagnosis of axSpA (Assessment of Spondyloarthritis International Society criteria). Clinical features, disease activity and functional indices, imaging were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRIs were scored by two readers following Spondyloarthritis Research Consortium of Canada score, Stoke Ankylosing Spondylitis Spinal Score System modified by Creemers and modified New York criteria. Characteristics of axSpA patients with/without psoriasis were compared over time with descriptive statistics; multivariate logistic regression model was constructed to assess predictors of spinal/pelvic radiographic progression. Eighty-eight patients had axSpA (84.1% non-radiographic; 15.9% radiographic); 36.4% had psoriasis. Patients with psoriasis were older; less frequently had HLA-B27+ and radiographic sacroiliitis with unilateral/asymmetric pattern and more signs of spondylitis. Functional and disease activity indices decreased with slightly higher BASDAI and BASFI in axSpA with psoriasis. All patients showed slight spinal/pelvic radiographic progression. Patients without psoriasis showed increased sacroiliitis progression and low-grade spinal progression. More inflammatory corner lesions on cervical/thoracic MRI-spine were observed in patients with psoriasis. A significant downtrend of SPARCC SIJ/spine scores in all patients was found. Psoriasis was a predictor of increased spinal progression (odds ratio = 0.18; 95% CI: 0.04, 0.78). Psoriasis was associated with distinct axSpA features, increased spinal radiographic progression and low-grade radiographic sacroiliitis.

POS1073 AXIAL PSORIATIC ARTHRITIS AND ANKYLOSING SPONDYLITIS. SAME OR DIFFERENT? A REAL-WORLD STUDY WITH EMPHASIS ON COMORBIDITIES

Background:Axial involvement affects 25-70% of psoriatic arthritis (PsA) patients, depending on the criteria used for its definition. Efforts are underway to clarify the similarities and differences between axial-PsA and ankylosing spondylitis (AS).Objectives:We aimed to compare, in a real-world setting, axial-PsA and AS, in terms of demographic, radiologic and clinical (musculoskeletal and extra-articular) characteristics, with a focus on comorbidities.Methods:All AS (New York criteria, n=128) and PsA patients (CASPAR criteria, n=78) with axial involvement who were regularly followed-up in the outpatients’ rheumatology clinics from two tertiary hospitals (December 2018-July 2020) were included. Axial-PsA was defined when both of the following were ever present: inflammatory axial symptoms and radiological findings in X-ray or MRI of the sacroiliac joints or the spine. The following findings were considered: sacroiliitis (unilateral ≥ grade 3 or bilateral ≥ grade 2), corner lesions or squaring in the vertebrae, syndesmophytes (marginal or para-marginal) and facet joints arthritis.Demographic, radiologic and clinical characteristics including comorbidities were compared between AS and axial-PsA. For comorbidities (Major Adverse Cardiovascular Events [MACE: combined coronary disease and cerebrovascular accidents], hypertension, diabetes mellitus, dyslipidemia, depression, osteoporosis, and malignancies), adjustments were made for relevant confounders as follows: MACE were adjusted for: age, gender, smoking, hypertension, dyslipidemia, disease duration, DM and non-steroidal anti-inflammatory drugs [NSAIDs] use; depression for: age, gender and disease duration; malignancy for: age, gender, disease duration; hypertension for: age, sex, BMI, NSAIDs use, smoking for; DM: age, sex, BMI, glucocorticoids treatment; osteoporosis for: age, sex, glucocorticoids treatment. Statistical significance is considered for p-values less than 0.05 and 0.1 in univariate and multivariate analyses, respectively.Results:AS patients were younger (p=0.05) and were diagnosed at a younger age (p=0.002), more frequently of male gender (p=0.04), had lower BMI (p=0.006) and they were more frequently HLA-B27-positive (p=0.006). In AS patients, peripheral arthritis, dactylitis and nail involvement were less common (p=0.001 for all), in contrast to eye (p=0.001) and bowel involvement (p=0.004). Frequency of radiologic abnormalities in the spine was similar between the two groups while sacroiliitis was more often bilateral in AS and unilateral in axial-PsA (p&lt;0.001 for both) Comorbidities, including MACE, were comparable between AS and axial-PsA, apart from depression which was more frequent in axial-PsA (Table 1. next page).Table 1.Comorbidities. Comparison between axial-PsA and AS. OR: odds ratio, MACE: Major cardiovascular events. * adjustments are reported in the textComorbiditiesaxial-PsA (n=79)AS(n=129)Crude OR(95%CI)Adjusted OR (95%CI)p-valueMACE* n (%)4 (5.1)6 (4.6)0.91 (0.25-3.34)1.73 (0.32-9.34)0.526Dyslipidemia n (%)37 (46.8)45 (34.9)0.61 (0.34-1.07)NA0.108Hypertension* n (%)27 (34.2)24 (18.6)0.44 (0.23-0.83)1.11 (0.38-3.21)0.843Diabetes mellitus* n (%)12 (15.2)10 (7.7)0.47 (0.19-1.14)1.65 (0.43-6.29)0.463Depression* n (%)19 (24.1)16 (12.4)0.44 (0.21-0.93)0.48 (0.22-1.07)0.07Osteoporosis* n (%)3 (3.8)10 (7.7)2.13 (0.57-7.98)2.40 (0.56-10.18)0.235Malignancies* n (%)3 (3.8)3 (2.3)0.60 (0.12-3.06)0.87 (0.16-4.70)0.870Conclusion:AS and axial-PsA have certain clinical and radiologic differences. Comorbidities were comparable, while depression was more common in axial-PsA.Disclosure of Interests:George E. Fragoulis: None declared, Maria Pappa: None declared, Gerasimos Evangelatos: None declared, Alexios Iliopoulos: None declared, Petros Sfikakis Grant/research support from: AbbVie, Pfizer, MSD, Roche, UCB, GSK, Novartis, Maria Tektonidou Grant/research support from: AbbVie, GSK, Genesis, MSD, Novartis, Pfizer, UCB.

POS0039 MRI LESIONS IN SPA: A COMPARISON WITH AGE AND SEX MATCHED PARTICIPANTS WITH NON-INFLAMMATORY BACK PAIN

Background:Magnetic resonance imaging (MRI) is becoming increasingly important in axial spondyloarthritis (SpA) due to its unique role in early diagnosis, classification, and monitoring of disease (1, 2). It is the only disease assessment tool that has been validated with histological inflammatory cellularity in tissue biopsy of the sacroiliac (SI) joint (3). However, many MRI lesions are not exclusive to axial SpA and may occur in other conditions such as infection, degeneration and malignancy. Further characterization of these lesions may guide more targeted therapies.Objectives:The objective of this study was to describe, investigate associated factors, and to compare individual MRI lesions with age and sex matched controls.Methods:This was a cross-sectional observational study of MRI lesions of 431 participants with axial SpA compared with 53 age and sex matched participants with non-inflammatory back pain. Individual lesions identified included: discovertebral lesions (DVL), facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL). Associated factors of the lesions were determined by regression analyses.Results:Compared to the control group, participants with axial SpA had more costovertebral lesions (12.5% vs 1.9%; p=0.02), CIL (46.6% vs 15.1%; p=0.03), and FCL (55.5% vs 39.6%; p=0.03). Multivariate regression showed that age (OR=1.02; p=0.03), regular alcohol use (OR=0.40; p=0.04) and radiographic axial SpA (OR=1.89; p=0.01) were associated with DVL; Chinese ethnicity (OR=0.06; p=0.01) and radiographic axial SpA (OR=3.63; p=0.01) were associated with facet joint lesion; radiographic axial SpA (OR=4.26; p&lt;0.001) was associated with costovertebral joint lesion; male gender (ß=1.10; p=0.01), HLA B27 (ß=1.02; p=0.02), and radiographic axial SpA (ß=1.05; p=0.01) were associated with CIL; age (ß=0.10; p&lt;0.01), male gender (ß=1.96; p=0.01), body weight (ß=0.11; p&lt;0.01), HLA B27 (ß=3.23; p&lt;0.001), and radiographic axial SpA (ß=1.77; p=0.02) were associated with FCL.Conclusion:The individual MRI lesions more specific to axial SpA when compared to non-inflammatory back pain were costovertebral joint lesions, CIL, and FCL.

Axial involvement in patients with early peripheral spondyloarthritis: a prospective MRI study of sacroiliac joints and spine

ObjectivesTo assess axial involvement on MRI in early peripheral spondyloarthritis (pSpA) and to evaluate whether axial inflammation predicts relapse on treatment withdrawal.MethodsFifty-six patients with early, active, newly diagnosed pSpA underwent...

Corrigendum to: An analysis of short-term repeat MRI scans of vertebral corner lesions in suspected early axSpA: defining the prevalence and evolution of clinically significant spinal lesions without concurrent SIJ changes on imaging.

Corrigendum to: An analysis of short-term repeat MRI scans of vertebral corner lesions in suspected early axSpA: defining the prevalence and evolution of clinically significant spinal lesions without concurrent SIJ changes on imaging.

Axial skeletal lesions and disease duration in SAPHO syndrome: A retrospective review of computed tomography findings in 81 patients.

To explore the relevance of disease duration with axial skeletal lesions in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome based on computed tomography (CT). Patients who had undergone whole-spine CT were included from a previously reported single-center cohort of SAPHO syndrome. Patients with previous treatments of bisphosphates, biological agents or surgeries were excluded. Sites of axial skeletal involvement were reviewed including the spine, sacroiliac joints, and anterior chest wall. Duration of osteoarticular involvement was defined as the interval between the onset of osteoarticular symptoms and the CT evaluation. Eighty-one patients (54 female and 27 male) were included in the study. The mean disease duration was 26.9±34.9months. Fifty (63.0%) patients showed spinal lesions on CT. The average numbers of involved vertebral segments for corner and endplate lesions were 3.16±3.51 and 0.73±1.85 respectively. Sixty-eight (84.0%) patients exhibited abnormalities in the anterior chest wall. The number of involved vertebral segments showed poor correlation with disease duration for both corner lesions (r2 =0.051, P=0.043) and endplate lesions (r2 =0.137, P=0.001). Patients with costoclavicular involvement showed remarkably longer disease duration than those without (49.3±47.7months vs 18.0±23.5months, P=0.006), while no significant difference was detected regarding other structures in the anterior chest wall. Costoclavicular involvement is a hallmark of long disease duration in SAPHO syndrome. Corner and endplate lesions in the vertebrae and sacroiliac involvement may not relate to disease course.

P271 An analysis of short-term repeat MRI scans of vertebral corner lesions in suspected early axSpA: defining the prevalence and evolution of clinically significant spinal lesions without concurrent SIJ changes on imaging

Abstract Background MRI offers an enhanced opportunity to detect early spinal changes of axial spondyloarthritis (axSpA), by identifying characteristic inflammatory and structural lesions, so called Romanus lesions. These include bone marrow oedema lesions on the vertebral corners and fatty replacement of these lesions, both highly suggestive features of axSpA. Current evidence suggests that treatment of these lesions requires early biologic therapy, hence early identification is imperative. We evaluate the prevalence and variation of vertebral corner lesions on short-term repeat MRI scans in patients with suspected early axSpA. Methods 109 MRI scans were performed at baseline and at 4, 8 and 12-weeks on 30 patients with suspected axial spondyloarthritis, who fulfilled the ASAS inflammatory back pain criteria, and had normal sacroiliac joints (SIJs) on antero-posterior pelvis radiographs. The protocol included sagittal T1 and short-tau inversion recovery of the cervico-thoracic spine and thoracolumbar spine. Results 29 patients completed the study (66% were male, 72% HLA-B2-positive). All patients had ≥1 clinical spondyloarthritis (SpA) feature and 86% had ≥2. 13 patients used NSAIDs regularly over the 12-week study period. Overall, 40 corner lesions were present in participants at baseline scanning. 67 new vertebral corner lesion changes occurred at different time points over the follow-up period compared to baseline. 43 changes were new or worsening lesions, while 24 changes were an improvement or resolution of a lesion. 48.6% (14/29) of patients had a minimum of 1 corner lesion present at baseline. 78.5% (11/14) of patients with baseline corner lesions experienced either a decrease/improvement or increase/progression of spinal corner lesions. 20.7% (6/29) of patients demonstrated transient corner lesions at baseline or follow-up with resolution by the 12-week scan (likely artefact). 5/29 patients met spinal imaging criteria suggestive of AS (3 at baseline, 1 only transiently at 1 month, and 1 which persisted from interval scanning). At 12-weeks, 13.8% of patients had at least 3 concomitant baseline or de-novo vertebral corner lesions present (minimum number needed for diagnostic significance). 75% of these patients did not have evidence of concomitant SIJ changes (10.3% of all patients). HLA-B27 status, gender, NSAID use, and number of SpA features were not associated with corner lesion development or improvement. Conclusion Approximately half of all patients who meet ASAS criteria for inflammatory back pain, but do not meet ASAS criteria for axSpA, demonstrated at least 1 vertebral corner lesion on MRI scan at baseline, which may represent artefact or a prelude to future disease progression. 13.8% of patients had at least 3 concomitant baseline or de-novo vertebral corner lesions present on MRI at the conclusion of 12-weeks of follow-up. In cases of suspected axSpA with negative SIJ MRI imaging, 10.3% of patients had significant spinal evidence of axSpA on MRI, highlighting the importance of spinal imaging and monitoring as part of the diagnostic work-up for axSpA. Disclosures S. Chatterjee None. H. Marzo-Ortega None. D. McGonagle None. A. Bennett None. R. Sengupta None.

Fatty corner lesions in T1-weighted magnetic resonance imaging as an alternative to sacroiliitis for diagnosis of axial spondyloarthritis

BackgroundA fatty corner lesion (FCL) is a well-demarcated fat infiltration in the corner of a vertebral body on T1 magnetic resonance imaging (MRI) sequence. It has been reported to be useful in the diagnosis of axial spondyloarthritis (axSpA). Our objective is to systematically evaluate the diagnostic accuracy of FCLs in tertiary centre patients with chronic back pain.MethodTwo hundred and thirty eight axSpA patients and 62 non-axSpA patients with back pain were recruited from five rheumatology centres. Clinical, biochemical, and radiological parameters were collected and all patients underwent a MRI of the spine and sacroiliac (SI) joints. FCLs in vertebral bodies from C4 to L5 were scored. The number and location of FCLs were clustered together to determine an optimal combination for diagnosis. Results were compared with expert diagnosis as the “gold standard”.ResultsFCLs of the anterior whole spine (AUC 0.62; p = 0.003) and anterior thoracic spine (AUC 0.64; p = 0.001) had diagnostic significance. Incorporating at least 5 whole spine FCLs into the imaging criteria of the Assessment of SpondyloArthritis international Society (ASAS) criteria for axSpA yielded a sensitivity of 91.6% and specificity of 91.9%. Similarly, applying at least 3 anterior thoracic FCLs to the imaging criteria of the ASAS axial SpA criteria yielded a sensitivity of 92.0% and specificity of 93.5%.ConclusionFCLs could be used to diagnose axial SpA. The presence of at least 3 anterior thoracic FCLs in T1-weighted MRI spine suggests a diagnosis of axial SpA without additional MRI of the SI joints.Trial registrationThe cohort has been registered in the clinical trial registry of the University of Hong Kong (HKUCTR-2087).

The Use of Magnetic Resonance Imaging in Axial Spondyloarthritis: Time to Bridge the Gap Between Radiologists and Rheumatologists.

Magnetic resonance imaging (MRI) is involved in the assessment of axial spondyloarthritis (axSpA); however, anecdotal evidence suggests diverse practice among radiologists. The objective of this study was to describe current practice in the use of MRI for assessment of axSpA by UK radiologists. Six hundred ninety-nine UK radiologists were invited to complete an online survey. Availability of MR scanners, familiarity with axSpA disease-specific lesions, and MRI protocols and definitions of positive sacroiliac joint (SIJ) or spinal MRI were assessed. Two-hundred sixty-nine radiologists (38%) from 131/180 (73%) acute UK National Health Service trusts/health boards responded. MRI waiting times < 2 months were reported by 90% of radiologists. Twenty-nine radiologists (11%) used contrast as standard, 256 (91%) used T1 and short-tau inversion recovery, and 172 (64%) also used T2 sequences. Five percent scanned only SIJ, 33% scanned SIJ and lumbar spine, 29% scanned SIJ and thoracolumbar spine, and 30% scanned SIJ and the whole spine. Mean scan time was 34 min. Eighteen percent did not use the subchondral bone marrow edema of the SIJ to help diagnose axSpA and 18% did not use the inflammatory vertebral corner lesions to assist diagnosis. Awareness of axSpA was reported by 75% of radiologists, and awareness of definitions for positive MRI of SIJ and spine by 31% and 25%, respectively. These data highlight the need for better rheumatology-radiology collaboration on the identification of diagnostic axSpA MRI lesions and support the need for a consensus on the most appropriate MRI protocols for the assessment of axSpA.

Whole-spine Computed Tomography Findings in SAPHO Syndrome.

We evaluated the whole-spine computed tomography (CT) findings in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome to improve our understanding of this rare disease. Whole-spine CT images obtained in 69 patients with SAPHO were reviewed. For each individual, a total of 25 vertebrae were evaluated for the distribution of affected vertebrae, CT manifestations of vertebral lesions, symmetry and location of distribution of the lesions on vertebrae, involvement pattern, and narrowing of adjacent intervertebral disc space. Paravertebral ligamentous ossifications, apophyseal joint disorders, and costovertebral joint disorders were also evaluated. All the 69 patients with SAPHO exhibited abnormalities on whole-spine CT. Sixty-four had vertebral lesions, 52 had paravertebral ossifications, and 47 had both. The vertebral lesions were observed in 441 vertebrae, with a predilection for thoracic spine. The lesions exhibited a mixture of cortical erosion, reactive osteosclerosis of surrounding cancellous bone, and syndesmophyte. They may be confined to the vertebral corner (65.1%) or be extensive, involving the endplate (34.9%). Corner lesions could start in any part of the epiphyseal ring. The lesions were asymmetrically distributed. The affected vertebrae were more consecutively involved in a "kissing" appearance (78.2%). Intervertebral disc spaces were usually normal or mildly narrowed. There were 320 foci of paravertebral ossifications observed, with a predilection for the supraspinous ligament. Paravertebral ossifications were delicate and segmental. Ossifications throughout annulus fibrosis and apophyseal joint were not observed. Our investigation of the distributional, morphological features and the involvement pattern of spinal lesions in patients with SAPHO demonstrated distinct CT characteristics.

Imaging for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome.

Multifocal osteomyelitis and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome constitute a spectrum of disease that includes inflammatory bone lesions and dermatologic findings. Radiographic features resemble those of the spondyloarthropathies with anterior chest wall involvement. Early radiographic findings are osteodestructive with lytic lesions. Bone scintigraphy of the sternoclavicular region classically yields a 'bull's head' pattern of radionuclide uptake. Magnetic resonance imaging (MRI) can demonstrate corner lesions of vertebral bodies. Ultrasound often reveals peripheral enthesitis. Late radiographic features are usually osteoproliferative. PET/CT can identify chronic lesions. Differential diagnostic considerations include osteomyelitis and malignancy, which often prompt bone biopsy.

AB0905 Late-onset spondyloarthropathy mimicking polymalgia rheumatica: Evidence from MRI

BackgroundPolymyalgia rheumatica (PMR) is a clinical syndrome, typically affecting older people, presenting with inflammatory musculoskeletal symptoms. Late onset rheumatoid arthritis is a well-known PMR mimic, but spondyloarthropathy (SpA) can also...

The Thoracic and Lumbar Spine in Severe Juvenile Idiopathic Arthritis: Magnetic Resonance Imaging Analysis in 50 Children

To determine the prevalence of vertebral fractures as a complication of juvenile idiopathic arthritis (JIA). This cross-sectional study evaluated the prevalence and characteristics of spinal abnormalities in 50 children (aged 7.0-18.7 years) with treatment-resistant JIA by magnetic resonance imaging. Vertebral deformities, endplate irregularities, intervertebral disc involvement, spinal canal, neural foramina, and back muscles were analyzed and correlated with clinical characteristics and bone mineral density. Magnetic resonance imaging revealed various abnormalities in 31 patients (62%). Vertebral compression was seen in 28%, disc degeneration in 46%, protrusions in 14%, prolapses in 4%, endplate changes in 26%, and anterior vertebral corner lesions in 16%. Two patients (4%) had mild spinal canal narrowing without medullar involvement; none had neural root compression. Six patients (12%) had mild back muscle atrophy. No correlation was observed between spinal fractures or other vertebral changes and disease activity or duration, pain or bone mineral density; patients with spinal fractures tended to have a higher recent glucocorticoid exposure (P=.086). Children with severe JIA have a high prevalence of compression fractures and other vertebral, endplate, and disc abnormalities in the thoracic and lumbar spine.

“MR Corner Sign”: Value for Predicting Presence of Ankylosing Spondylitis

The purpose of this study was to evaluate the MRI features of the "MR corner sign" and to determine its diagnostic usefulness in ankylosing spondylitis. We reviewed the spinal MR images of 52 patients with ankylosing spondylitis and compared these images with those of 52 age- and sex-matched control subjects. The MR corner sign was defined as a triangular and sharply marginated corner abnormality in a vertebral body unassociated with osteophytes or Schmorl's node. MR corner lesions were significantly more common in the ankylosing spondylitis group than in the control group (Fisher's exact test, p < 0.001). The sensitivity, specificity, and positive and negative predictive values of the MR corner sign were 44%, 96%, 92%, and 63%, respectively. The most frequent feature of signal intensity was a Modic type II change (77%). In patients with ankylosing spondylitis, the MR corner sign was fre quently seen at the thoracolumbar junction, whereas degenerative corner lesions were commonly seen in the lower lumbar spine. When the MR corner sign is detected on spinal MR images in daily practice, it should not be overlooked because it suggests the possibility of ankylosing spondylitis, which should then be further evaluated.