Ankylosing Spondylitis

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• A 30-year-old patient

• Presence of HLA-B27

• Dorsal and lumbar pain

• Stiffness for more than 10 months that improves with exercise but is not relieved by rest

Fig. 1

Sagittal SE T1-weighted image (a), sagittal TSE T2-weighted image (b), sagittal TSE T2-weighted images with fat saturation (c–d), sagittal SE T1-weighted image with fat saturation following the administration of contrast medium (e–f). These images show a low signal at T12, L1, L2, and L3 with focal fat infiltration at vertebral corners of L1 and L2 (chronic inflammatory lesions) (a); T2-weighted image shows a mild hyperintensity at the same levels, while fat saturated T2-weighted image shows a more marked hyperintensity of the same lesions (c–d). Contrast medium administration shows enhancement of the vertebral corners and endplates of thoracic and lumbar spine (e, f, asterisks). Note how the post-contrast images also show pronounced enhancement of interspinal and supraspinous ligaments, a finding indicative of enthesitis (e–f, arrows)

Follow-up after 6 months of TNF-blocker therapy

Fig. 2

Sagittal SE T1-weighted sequences (a–b), sagittal TSE T2-weighted images with fat saturation (c–d), sagittal SE T1-weighted images with fat saturation following the administration of contrast medium (e–f). Focal fat infiltration of the thoracic and lumbar vertebral corners (a–b), with the absence of bone marrow edema(c–d); images after contrast medium administration confirm the resolution of the inflammation, with a minimal enhancement of the superior corner of T11 (e–f)