Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2004 Apr 5;63(9):1046–1055. doi: 10.1136/ard.2003.019968

Analysing chronic spinal changes in ankylosing spondylitis: a systematic comparison of conventional x rays with magnetic resonance imaging using established and new scoring systems

J Braun 1, X Baraliakos 1, W Golder 1, K Hermann 1, J Listing 1, J Brandt 1, M Rudwaleit 1, S Zuehlsdorf 1, M Bollow 1, J Sieper 1, D van der Heijde 1
PMCID: PMC1755114  PMID: 15066862

Abstract

Objectives: To compare conventional radiography and magnetic resonance imaging (MRI) for detection of chronic changes in the spine of patients with ankylosing spondylitis (AS).

Methods: Assessment of chronic lesions in conventional x rays and T1 weighted MRI turbo spin echo sequences was performed with the established x ray scores BASRI and SASSS, the new Berlin score, and the MRI scoring system ASspiMRI-c All images were read twice and "blindly" by two readers. One vertebral unit (VU) was defined as the region between two virtual lines drawn through the middle of each vertebra. Definite involvement was defined as a score ⩾2 in a spinal segment.

Results: Thirty nine patients with AS were examined (25 (64%) male, mean age 40.9 years, 33/36 (92%) HLA-B27 positive). The Berlin score correlated with the BASRI (r = 0.73, p = 0.01). The ASspiMRI-c correlated well with the BASRI and the Berlin score (r = 0.66 and r = 0.51, respectively, p = 0.01). The Berlin x ray score showed that 12/35 (34.3%), 13/35 (37.1%), and 12/28 (31.6%) patients had definite involvement of the cervical spine (CS), thoracic spine (TS), and lumbar spine (LS), respectively. The ASspiMRI-c showed that 10/36 (27.8%), 21/36 (58.3%), and 9/35 (25.7%) patients had definite involvement of the CS, TS, and LS, respectively. Syndesmophytes were found in 14.4% of all VUs with 90% agreement between the SASSS and Berlin score.

Conclusions: T1 weighted MRI can detect chronic lesions in AS. The two new scoring systems proved valid in comparison with established scoring systems and based on aspects of the OMERACT filter. The thoracic spine is most commonly affected in AS. This part of the spine is best assessed by MRI.

Full Text

The Full Text of this article is available as a PDF (324.5 KB).

Figure 1.

Figure 1

Open in a new tab

 The Berlin x ray score, a new scoring system to evaluate conventional x ray findings of the spine of patients with AS

Figure 7.

Figure 7

Open in a new tab

 Anterior syndesmophytes between L2/3, L3/4, and L4/5 as detected by x ray examination. By using the Berlin x ray score, the VU L2/3 is scored with a scoring grade of 3 (small syndesmophytes) and VUs L3/4 and L4/5 are scored with a scoring grade of 5 (bridging syndesmophytes).

Figure 9.

Figure 9

Open in a new tab

 Ventral syndesmophytes and a medial erosion of the lumbar spine as a sign of chronic changes in the spine of a patient with AS. Berlin score (left image): grade 5 (bridging syndesmophytes); ASspiMRI-c score (right image): grade 4 (erosion). One difference between the two imaging techniques is that osteophytes are more easily seen with x rays than with MRI. T1 weighted MRI can visualise the signs of erosion more clearly than x rays.

Figure 10.

Figure 10

Open in a new tab

 Thoracolumbar region of a patient with AS. The anterior syndesmophytes are clearly seen radiologically (grading 5 and 6 in the Berlin score) (A), whereas T1 MR images (B) show more indirectly the hypertrophic reaction as a sign of chronic bony changes.

Figure 2.

Figure 2

Open in a new tab

 Definition of a VU for using the Berlin x ray score and the ASspiMRI-c for T1 MRI in evaluation of the spine of patients with AS.

Figure 3.

Figure 3

Open in a new tab

 Grading system for assessing chronic spinal lesions in patients with AS by T1 MRI.

Figure 8.

Figure 8

Open in a new tab

 Vertebral anterior bridging between two VUs in the thoracic spine, indicating a score of 5 in the ASspiMRI-c (T1 MR image).

Figure 4.

Figure 4

Open in a new tab

 Relative affection of each VU, as seen by x ray examination using the lateral view Berlin x ray score for evaluation of chronic spinal changes in patients with AS. Values are shown as the percentage of affection. **VU with the most frequent affection in each spinal segment.

Figure 6.

Figure 6

Open in a new tab

 Relative affection of each VU, as seen by x ray examination using the SASS score for evaluation of chronic spinal changes in patients with AS. Values are shown as the percentage of affection. u, upper edge of the VU; d, lower edge of the VU; SS, sacral spine. **VU with the most frequent affection in each spinal segment.

Figure 5.

Figure 5

Open in a new tab

 Relative affection of each VU, as seen by x ray examination using the ASspiMRI-c score for evaluation of chronic spinal changes in patients with AS. Values are shown as the percentage of affection. **VU with the most frequent affection in each spinal segment.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Averns H. L., Oxtoby J., Taylor H. G., Jones P. W., Dziedzic K., Dawes P. T. Radiological outcome in ankylosing spondylitis: use of the Stoke Ankylosing Spondylitis Spine Score (SASSS). Br J Rheumatol. 1996 Apr;35(4):373–376. doi: 10.1093/rheumatology/35.4.373. [DOI] [PubMed] [Google Scholar]
  2. Bollow M., Enzweiler C., Taupitz M., Golder W., Hamm B., Sieper J., Braun J. Use of contrast enhanced magnetic resonance imaging to detect spinal inflammation in patients with spondyloarthritides. Clin Exp Rheumatol. 2002 Nov-Dec;20(6 Suppl 28):S167–S174. [PubMed] [Google Scholar]
  3. Bollow M., Fischer T., Reisshauer H., Backhaus M., Sieper J., Hamm B., Braun J. Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis- cellularity correlates with the degree of enhancement detected by magnetic resonance imaging. Ann Rheum Dis. 2000 Feb;59(2):135–140. doi: 10.1136/ard.59.2.135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brandt J., Haibel H., Cornely D., Golder W., Gonzalez J., Reddig J., Thriene W., Sieper J., Braun J. Successful treatment of active ankylosing spondylitis with the anti-tumor necrosis factor alpha monoclonal antibody infliximab. Arthritis Rheum. 2000 Jun;43(6):1346–1352. doi: 10.1002/1529-0131(200006)43:6<1346::AID-ANR18>3.0.CO;2-E. [DOI] [PubMed] [Google Scholar]
  5. Braun J., Baraliakos X., Golder W., Brandt J., Rudwaleit M., Listing J., Bollow M., Sieper J., Van Der Heijde D. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum. 2003 Apr;48(4):1126–1136. doi: 10.1002/art.10883. [DOI] [PubMed] [Google Scholar]
  6. Braun J., Bollow M., Eggens U., König H., Distler A., Sieper J. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum. 1994 Jul;37(7):1039–1045. doi: 10.1002/art.1780370709. [DOI] [PubMed] [Google Scholar]
  7. Braun J., Bollow M., Neure L., Seipelt E., Seyrekbasan F., Herbst H., Eggens U., Distler A., Sieper J. Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum. 1995 Apr;38(4):499–505. doi: 10.1002/art.1780380407. [DOI] [PubMed] [Google Scholar]
  8. Braun J., Bollow M., Remlinger G., Eggens U., Rudwaleit M., Distler A., Sieper J. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 1998 Jan;41(1):58–67. doi: 10.1002/1529-0131(199801)41:1<58::AID-ART8>3.0.CO;2-G. [DOI] [PubMed] [Google Scholar]
  9. Braun J., Bollow M., Sieper J. Radiologic diagnosis and pathology of the spondyloarthropathies. Rheum Dis Clin North Am. 1998 Nov;24(4):697–735. doi: 10.1016/s0889-857x(05)70038-7. [DOI] [PubMed] [Google Scholar]
  10. Braun J., Sieper J. The sacroiliac joint in the spondyloarthropathies. Curr Opin Rheumatol. 1996 Jul;8(4):275–287. doi: 10.1097/00002281-199607000-00003. [DOI] [PubMed] [Google Scholar]
  11. Braun J., van der Heijde D. Imaging and scoring in ankylosing spondylitis. Best Pract Res Clin Rheumatol. 2002 Sep;16(4):573–604. [PubMed] [Google Scholar]
  12. Calin A., Garrett S., Whitelock H., Kennedy L. G., O'Hea J., Mallorie P., Jenkinson T. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994 Dec;21(12):2281–2285. [PubMed] [Google Scholar]
  13. Chmura Kraemer Helena, Periyakoil Vyjeyanthi S., Noda Art. Kappa coefficients in medical research. Stat Med. 2002 Jul 30;21(14):2109–2129. doi: 10.1002/sim.1180. [DOI] [PubMed] [Google Scholar]
  14. MacKay K., Mack C., Brophy S., Calin A. The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum. 1998 Dec;41(12):2263–2270. doi: 10.1002/1529-0131(199812)41:12<2263::AID-ART23>3.0.CO;2-I. [DOI] [PubMed] [Google Scholar]
  15. McGonagle D., Gibbon W., O'Connor P., Green M., Pease C., Emery P. Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum. 1998 Apr;41(4):694–700. doi: 10.1002/1529-0131(199804)41:4<694::AID-ART17>3.0.CO;2-#. [DOI] [PubMed] [Google Scholar]
  16. Muche B., Bollow M., François R. J., Sieper J., Hamm B., Braun J. Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum. 2003 May;48(5):1374–1384. doi: 10.1002/art.10934. [DOI] [PubMed] [Google Scholar]
  17. Spoorenberg A., de Vlam K., van der Heijde D., de Klerk E., Dougados M., Mielants H., van der Tempel H., Boers M., van der Linden S. Radiological scoring methods in ankylosing spondylitis: reliability and sensitivity to change over one year. J Rheumatol. 1999 Apr;26(4):997–1002. [PubMed] [Google Scholar]
  18. Stone M., Salonen D., Lax M., Payne U., Lapp V., Inman R. Clinical and imaging correlates of response to treatment with infliximab in patients with ankylosing spondylitis. J Rheumatol. 2001 Jul;28(7):1605–1614. [PubMed] [Google Scholar]
  19. van der Linden S., Valkenburg H. A., Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984 Apr;27(4):361–368. doi: 10.1002/art.1780270401. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES