Presentation
Low back pain.
Patient Data
Multilevel symmetrical dorsolumbar anterior and posterior bridging osteophytes, symmetrical marginal syndesmophytes, more conspicuous at the lower dorsal level and multilevel fat signal intensity noted in the intervertebral discs associated with joint space narrowing and ankylosis of the inferior aspect of both sacroiliac joints likely suggesting ankylosing spondylitis.
Case Discussion
Spondylosis is a seronegative spondyloarthropathy typically seen in young males affecting the sacroiliac joint first with multisystemic manifestations and multiple associations.
In this case, many of the typical features of ankylosing spondylitis are seen such as ankylosing of the sacroiliac joints, bilateral symmetrical osteophytes, and marginal syndesmophytes.
High T1 signal intensity seen in the intervertebral disc could be related to fat, melanin hemorrhage, or calcification in some cases.
Fat suppression sequences are useful in differentiating fat from other high T1 signal intensities.
While fatty degeneration of the intervertebral discs is a described entity It will not be associated with other pathological findings.
High T1 signal intensity in the intervertebral disc has been described in ankylosing spondylitis as well as other diseases such as hemochromatosis, chondrocalcinosis, hyperparathyroidism, poliomyelitis, acromegaly, amyloidosis and multiple myeloma.
When all the radiological features seen in this case are combined together; the diagnosis of ankylosing spondylitis becomes highly probable.
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