spondyloarthropathy ( RID3603 )
I read the sacral MRI and someone else read the L spine, both done yesterday. The right SIJ changes are obviously inflammatory and not traumatic. I think the T1 axial shows partial ankylosis of the left SIJ. Our L Sp protocol includes STIR in Sag. That was read as no significant marrow lesions. Scrolling laterally you can see the marked BME in the right sacrum. I think there are subtle Romanus lesions, though, without sacral MRI, I would have a difficult time distinguishing from discogenic change (though only the L5-S1 disc looks dehydrated). Slide 3 is from 3 yrs ago when he was 27; the radiologist did not scroll laterally then either and reported no marrow lesions: at that time there was marked BME in the sacrum bilaterally. This argues both for the necessity of including a STIR sequence covering the SIJ on lumbar MRI (and actually looking at all of the images)...if not routinely, certainly for younger patients. (I seem to have upended this mans personal injury claim) What are your thoughts? [ Article ]

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