Hello Cindy (heigh, you are too kind hon, only doin what I love to do, diggin, leaving no stone unturned - an prob boring ridgid any number of people off into the bargain! <LOL>)- Romanus lesions, named after R. Romanus, who noted these 'lesions' in spondy patients. Facinating. See the link I posted above to Imaging, very good paper, excellent overview of imaging in spondyloarthritis:
http://radiographics.rsna.org/content/25/3/559.full Spinal Changes in Patients with Spondyloarthritis: Comparison of MR Imaging and Radiographic Appearances.References (section): Romanus R, Yden S. Destructive and ossifying spondylitic changes in rheumatoid ankylosing spondylitis. Acta Orthop Scand 1952; 22: 88–99.Medline22.↵JevticV, Kos-Golja M, Rozman B, McCall I.
Marginal erosive discovertebral “Romanus” lesions in ankylosing spondylitis demonstrated by contrast enhanced Gd-DTPA magnetic resonance imaging. Skeletal Radiol 2000; 29: 27–33.CrossRefMedline
Check out fig. 5c :
(here's the text)Figure 5c. Arthritis of the zygapophyseal joints in a 32-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the thoracic spine shows a posterior shiny corner at T9–10. (b) Sagittal T1-weighted fast spin-echo image shows circumscribed loss of signal intensity in the area of the vertebral arch (arrows) and zygapophyseal joints. (c) Sagittal contrast-enhanced fat-saturated T1-weighted image shows pronounced enhancement of the vertebral arch, articular processes, and adjacent soft tissue (arrows),
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And fig. 2a:
Figure 2a. Spondylitis (inactive Romanus lesions) in a 39-year-old patient with ankylosing spondylitis. (a) Lateral radiograph of the lumbar region shows syndesmophytes (arrows) at L3 through S1 and a shiny corner at the superior endplate of L5. (b) On the corresponding T1-weighted fast spin-echo image, the syndesmophyte at L5 (lower long arrow) is barely visible.
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(snip...) "The underlying anatomic structure is the epiphyseal ring in juvenile patients; in adults, it is fused with the vertebral body. Later in the course of the disease,
sclerotic changes of the edges of the vertebral endplates appear, findings referred to as “shiny corners.” MR imaging allows for the detection of Romanus lesions in both early and late spondyloarthritis. In active disease, these lesions are depicted as reduced signal intensity of the rim of the endplate on T1-weighted MR images and as increased signal intensity on STIR images (Fig 1) and represent bone marrow edema or osteitis (22). The condition is designated anterior spondylitis when the changes involve only the anterior vertebral edge, posterior spondylitis when they involve the posterior edge, and marginal spondylitis when combined changes are seen. The changes described occur exactly at the site of attachment of the anulus fibrosus to the vertebral endplate. Because such a junction of bone and ligamentous structure is an enthesis by definition, anterior or posterior spondylitis can be regarded as an enthesitis."
See also fig. 4a and 4b - which covers pretty much my own fracture..!
This is assuredly one of the best papers I have come across. Think in fact it is a 'must read' for all spondy persons, so that they can be informed as to 'what' those spinal changes are and...how best these changes may be viewed: MRI Saggital STIR imaging,
AND the new, uMRI: Multi Positional Upright MRI The uMRI permits of the 'loading' of the body, I refer to it a bit like to 'loading' of a supportive wall, IF the cement is good the loading will be firm and strong, if defective, will show up nicely but ONLY when that wall is shown as loaded as opposed to prone imaging. OK. A bit on the simplistic side, but ya get the picture!
Will forever thank (thanks to a wonderful KA member who introduced me to her) that excellent rhuematologist I was consulting with in the UK. Terrific lady. Wish I had as good a rheumy over here...
Hope this is helpful - will post more as I dig em out
