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Ann Rheum Dis. Sep 2004; 63(9): 1046–1055.
Published online Apr 5, 2004. doi:  10.1136/ard.2003.019968
PMCID: PMC1755114

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


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 [gt-or-equal, slanted]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.

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Selected References

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Figures and Tables

Figure 1
 The Berlin x ray score, a new scoring system to evaluate conventional x ray findings of the spine of patients with AS
Figure 7
 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 ...
Figure 9
 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). ...
Figure 10
 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 ...
Figure 2
 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
 Grading system for assessing chronic spinal lesions in patients with AS by T1 MRI.
Figure 8
 Vertebral anterior bridging between two VUs in the thoracic spine, indicating a score of 5 in the ASspiMRI-c (T1 MR image).
Figure 4
 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 ...
Figure 6
 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; ...
Figure 5
 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 ...

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