Answer for CoW 07 Jan 2018
Chronic Romanus Lesion
Findings
Multiple T1 / T2 hyperintense foci in the antero-superior corners of L3 to L5 vertebral bodies – Suggestive of fatty Romanus lesion(Chronic) Focal sclerosis noted in antero superior L3 vertebral body – Shiny Corner sign Mild subchondral sclerosis in both the iliac bones (abutting the sacroiliac joints) as well as in the inferior sacral aspect in the right side. The above features reflect Axial Spondyloarthropathy
Discussion
Fatty changes at vertebral corners have been reported on MRI in ankylosing spondylitis) .It is a diagnostic imaging feature of axial-SpA, which may be useful where inflammatory changes are absent on fat-suppression MRI and where radiography is normal. The Romanus lesion is one of the earliest signs in the spine of inflammatory spondyloarthritis. It represents inflammatory changes at the insertion of the annulus of the disc to the endplate and is an enthesitis. It is more often seen anteriorly but can also be posterior or a combination of both. The changes seen are progressive, beginning with acute inflammatory change and erosion at the vertebral body corners ( low T1 and high T2 signal), followed by Fatty replacement ( high T1 and T2 signal) and eventually sclerosis ( low T1 and T2). On CT its the later stages that are seen with sclerosis at the corners (Shiny Corner Sign)
Findings
Multiple T1 / T2 hyperintense foci in the antero-superior corners of L3 to L5 vertebral bodies – Suggestive of fatty Romanus lesion(Chronic) Focal sclerosis noted in antero superior L3 vertebral body – Shiny Corner sign Mild subchondral sclerosis in both the iliac bones (abutting the sacroiliac joints) as well as in the inferior sacral aspect in the right side. The above features reflect Axial Spondyloarthropathy
Discussion
Fatty changes at vertebral corners have been reported on MRI in ankylosing spondylitis) .It is a diagnostic imaging feature of axial-SpA, which may be useful where inflammatory changes are absent on fat-suppression MRI and where radiography is normal. The Romanus lesion is one of the earliest signs in the spine of inflammatory spondyloarthritis. It represents inflammatory changes at the insertion of the annulus of the disc to the endplate and is an enthesitis. It is more often seen anteriorly but can also be posterior or a combination of both. The changes seen are progressive, beginning with acute inflammatory change and erosion at the vertebral body corners ( low T1 and high T2 signal), followed by Fatty replacement ( high T1 and T2 signal) and eventually sclerosis ( low T1 and T2). On CT its the later stages that are seen with sclerosis at the corners (Shiny Corner Sign)
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!