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“MR Corner Sign” Useful in Detection of Early Ankylosing Spondylitis

July 7, 2009
Written by: , Filed in: Musculoskeletal Radiology
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Ankylosing spondylitis (AS) results in inflammation in the anterior aspect at the discovertebral junction. These early erosions are termed “Romanus lesions.” With healing, these erosions become sclerotic, resulting in the so-called “shiny corners” on radiographs.

A recent study was conducted to evaluate the MRI features of the “MR corner sign,” and to determine its diagnostic usefulness in ankylosing spondylitis.

Methodology
A retrospective review was done of 52 spine MRIs in patients with known ankylosing spondylitis and of 52 sex- and age-matched control subjects.

The MR corner sign was defined as well-defined triangular or square marrow abnormalities at the discovertebral junctions, without associated erosions, osteophytes, or Schmorl’s node.

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging

Results
MR corner lesions were found much more commonly in the Ankylosing Spondylitis group than in the control group (P <0.001). Sensitivity was 44% and specificity was 96%. The positive and negative predictive values were 92% and 63%, respectively. MR corner lesions increased with patient age in a linear association (P =0.002). No difference was found between age groups for level of the lesions or signal intensity. Anterior corner lesions were more frequent than posterior corner lesions. Corner lesions in Ankylosing Spondylitis were more frequently seen at the thoracolumbar junction, whereas degenerative corner lesions were more often seen in the lumbar spine. For degenerative lesions, Modic II changes were most frequent. There were 2 false-positive cases. Conclusions
The MR corner sign proves useful in detection of early ankylosing spondylitis and should not be overlooked.

Reviewer’s Comments

A limitation of this study as mentioned by the authors was exclusion of other seronegative spondylarthropathies.

Author: Cornelia Wenokor, MD

Reference:
Kim NR, Choi J-Y, et al. “MR Corner Sign”: Value for Predicting Presence of Ankylosing Spondylitis. AJR; 2008; 191 (July): 124-128

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging


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