Shiny corner sign (ankylosing spondylitis)

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The shiny corner sign is a spinal finding in ankylosing spondylitis, representing reactive sclerosis secondary to inflammatory erosions at the superior and inferior endplates (corners on lateral radiograph) of the vertebral bodies, which are known as Romanus lesions. Eventually, the vertebral bodies become squared (see vertebral body squaring for other causative entities).

Radiographic features

There is an ongoing international debate about specificity. Although axial spondyloarthritis is characterised by typical MR imaging features ⁵, these findings may not be totally specific and may be seen in degenerative or other spinal disorders as well ², as all forms of spondyloarthritis may ultimately develop into ankylosing spondylitis in patients with longstanding disease ².

~~Radiographic features~~

Plain radiograph

Triangular regions of sclerosis are classically seen at the superior and inferior vertebral endplates anteriorly (corners). This occurs as a response to inflammatory Romanus erosions, which may be seen concomitantly with the sclerotic "shiny corners" ⁶.

MRI

MR imaging allows for the detection of Romanus lesions and shiny corners in both early and late spondyloarthritis, respectively ².

In active disease, these lesions are depicted as reduced signal intensity of the rim of the endplate on T1 images and as increased signal intensity on STIR images, representing bone marrow oedema or osteitis. At this stage, plain films appear normal or may show Romanus erosions. Later in the disease course, the epiphyseal ring can appear hyperintense on T1WI. Such hyperintense lesions represent circumscribed areas of post-inflammatory fatty bone marrow degeneration. Only at this stage are shiny corners depicted by conventional radiography - that is, long after inflammation has run its course.

-<p>The <strong>shiny corner sign</strong> is a spinal finding in <a href="/articles/ankylosing-spondylitis-1">ankylosing spondylitis</a>, representing reactive sclerosis secondary to inflammatory erosions at the superior and inferior endplates (corners on lateral radiograph) of the vertebral bodies, which are known as <a href="/articles/romanus-lesion-vertebral-bodies">Romanus lesions</a>. Eventually, the vertebral bodies become squared (see <a href="/articles/vertebral-body-squaring-differential">vertebral body squaring</a> for other causative entities).</p><p>There is an ongoing international debate about specificity. Although axial spondyloarthritis is characterised by typical MR imaging features <sup>5</sup>, these findings may not be totally specific and may be seen in degenerative or other spinal disorders as well <sup>2</sup>, as all forms of spondyloarthritis may ultimately develop into ankylosing spondylitis in patients with longstanding disease <sup>2</sup>.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Triangular regions of sclerosis are classically seen at the superior and inferior vertebral endplates anteriorly (corners). This occurs as a response to inflammatory <a href="/articles/romanus-lesion-vertebral-bodies">Romanus erosions</a>, which may be seen concomitantly with the sclerotic "shiny corners" <sup>6</sup>. </p><h5>MRI</h5><p>MR imaging allows for the detection of Romanus lesions and shiny corners in both early and late spondyloarthritis, respectively <sup>2</sup>.</p><p>In active disease, these lesions are depicted as reduced signal intensity of the rim of the endplate on <a href="/articles/t1-weighted-image">T1</a> images and as increased signal intensity on <a href="/articles/stir">STIR</a> images, representing bone marrow oedema or osteitis. At this stage, plain films appear normal or may show Romanus erosions. Later in the disease course, the epiphyseal ring can appear hyperintense on T1WI. Such hyperintense lesions represent circumscribed areas of post-inflammatory fatty bone marrow degeneration. Only at this stage are shiny corners depicted by conventional radiography - that is, long after inflammation has run its course.</p>
+<p>The <strong>shiny corner sign</strong> is a spinal finding in <a href="/articles/ankylosing-spondylitis-1">ankylosing spondylitis</a>, representing reactive sclerosis secondary to inflammatory erosions at the superior and inferior endplates (corners on lateral radiograph) of the vertebral bodies, which are known as <a href="/articles/romanus-lesion-vertebral-bodies">Romanus lesions</a>. Eventually, the vertebral bodies become squared (see <a href="/articles/vertebral-body-squaring-differential">vertebral body squaring</a> for other causative entities).</p><h4>Radiographic features</h4><p>There is an ongoing international debate about specificity. Although axial spondyloarthritis is characterised by typical MR imaging features <sup>5</sup>, these findings may not be totally specific and may be seen in degenerative or other spinal disorders as well <sup>2</sup>, as all forms of spondyloarthritis may ultimately develop into ankylosing spondylitis in patients with longstanding disease <sup>2</sup>.</p><h5>Plain radiograph</h5><p>Triangular regions of sclerosis are classically seen at the superior and inferior vertebral endplates anteriorly (corners). This occurs as a response to inflammatory <a href="/articles/romanus-lesion-vertebral-bodies">Romanus erosions</a>, which may be seen concomitantly with the sclerotic "shiny corners" <sup>6</sup>. </p><h5>MRI</h5><p>MR imaging allows for the detection of Romanus lesions and shiny corners in both early and late spondyloarthritis, respectively <sup>2</sup>.</p><p>In active disease, these lesions are depicted as reduced signal intensity of the rim of the endplate on <a href="/articles/t1-weighted-image">T1</a> images and as increased signal intensity on <a href="/articles/stir">STIR</a> images, representing bone marrow oedema or osteitis. At this stage, plain films appear normal or may show Romanus erosions. Later in the disease course, the epiphyseal ring can appear hyperintense on T1WI. Such hyperintense lesions represent circumscribed areas of post-inflammatory fatty bone marrow degeneration. Only at this stage are shiny corners depicted by conventional radiography - that is, long after inflammation has run its course.</p>

References changed:

1. Ronald L. Eisenberg. Clinical Imaging. (2010) ISBN: 9780781788601 - <a href="http://books.google.com/books?vid=ISBN9780781788601">Google Books</a>
2. Hermann K, Althoff C, Schneider U et al. Spinal Changes in Patients with Spondyloarthritis: Comparison of MR Imaging and Radiographic Appearances. Radiographics. 2005;25(3):559-69; discussion 569. <a href="https://doi.org/10.1148/rg.253045117">doi:10.1148/rg.253045117</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/15888608">Pubmed</a>
3. Kim N, Choi J, Hong S et al. "MR Corner Sign": Value for Predicting Presence of Ankylosing Spondylitis. AJR Am J Roentgenol. 2008;191(1):124-8. <a href="https://doi.org/10.2214/AJR.07.3378">doi:10.2214/AJR.07.3378</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18562734">Pubmed</a>
4. Romanus R & Yden S. Destructive and Ossifying Spondylitic Changes in Rheumatoid Ankylosing Spondylitis (Pelvo-Spondylitis Ossificans). Acta Orthop Scand. 1952;22(2):88-99. <a href="https://doi.org/10.3109/17453675208988998">doi:10.3109/17453675208988998</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/13030181">Pubmed</a>
5. Bennett A, Rehman A, Hensor E, Marzo-Ortega H, Emery P, McGonagle D. The Fatty Romanus Lesion: A Non-Inflammatory Spinal MRI Lesion Specific for Axial Spondyloarthropathy. Ann Rheum Dis. 2010;69(5):891-4. <a href="https://doi.org/10.1136/ard.2009.112094">doi:10.1136/ard.2009.112094</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19666937">Pubmed</a>
6. Reinders A & Van Wyk M. Bamboo Spine – X-Ray Findings of Ankylosing Spondylitis Revisited. S Afr J Radiol. 2012;16(3):111-3. <a href="https://doi.org/10.4102/sajr.v16i3.294">doi:10.4102/sajr.v16i3.294</a>
1. Eisenberg RL. Clinical Imaging, An Atlas of Differential Diagnosis. Lippincott Williams & Wilkins. (2009) ISBN:0781788609. <a href="http://books.google.com/books?vid=ISBN0781788609">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/0781788609?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0781788609">Find it at Amazon</a><div class="ref_v2"></div>
2. Hermann KG, Althoff CE, Schneider U et-al. Spinal changes in patients with spondyloarthritis: comparison of MR imaging and radiographic appearances. Radiographics. 25 (3): 559-69. <a href="http://dx.doi.org/10.1148/rg.253045117">doi:10.1148/rg.253045117</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/15888608">Pubmed citation</a><div class="ref_v2"></div>
3. Kim NR, Choi JY, Hong SH et-al. "MR corner sign": value for predicting presence of ankylosing spondylitis. AJR Am J Roentgenol. 2008;191 (1): 124-8. <a href="http://dx.doi.org/10.2214/AJR.07.3378">doi:10.2214/AJR.07.3378</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18562734">Pubmed citation</a><div class="ref_v2"></div>
4. Romanus R, Yden S. Destructive and ossifying spondylitic changes in rheumatoid ankylosing spondylitis (pelvo-spondylitis ossificans). Acta Orthop Scand. 2003;22 (2): 88-99. <a href="http://www.ncbi.nlm.nih.gov/pubmed/13030181">Pubmed citation</a><span class="auto"></span>
5. Bennett AN, Rehman A, Hensor EM et-al. The fatty Romanus lesion: a non-inflammatory spinal MRI lesion specific for axial spondyloarthropathy. Ann. Rheum. Dis. 2010;69 (5): 891-4. <a href="http://dx.doi.org/10.1136/ard.2009.112094">doi:10.1136/ard.2009.112094</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19666937">Pubmed citation</a><span class="auto"></span>
6. Antoinette Reinders, Matthys J van Wyk. Bamboo spine – X-ray findings of ankylosing spondylitis revisited. (2012) South African Journal of Radiology. 16 (3): 111. Antoinette Reinders, Matthys J van Wyk. Bamboo spine – X-ray findings of ankylosing spondylitis revisited. (2012) South African Journal of Radiology. 16 (3): 111. <a href="https://doi.org/10.4102/sajr.v16i3.294">doi:10.4102/sajr.v16i3.294</a> <span class="ref_v4"></span>

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