Magnetic resonance diagnosis of ankylosing spondylitis and evaluation of the response to treatment

Objective. To show the role of magnetic resonance imaging in the early diagnosis of ankylosing spondylitis and discuss its possible usefulness in evaluating the response to treatment. Material and methods. We describe the findings on magnetic resonance images using STIR and contrast-enhanced T1-weighted sequences in 13 patients diagnosed with ankylosing spondylitis receiving adalimumab treatment. Magnetic resonance images were acquired at baseline and after six months. We describe the findings obtained and the results of the quantitative analysis of vertebral affection (using the ASspiMRI-a score), and sacroiliac and hip joint affection. Results. Inflammatory effects were demonstrated in 12 patients as signal hyperintensity in STIR sequences and as contrast enhancement in T1-weighted sequences. After treatment, 12 patients showed decreased ASspiMRI-a score and less affection in the sacroiliac and hip joints. No changes were observed in the remaining patient. Two patients showed posterior vertebral element involvement and disc involvement was seen in three. Conclusions. MRI opens up new possibilities for the management of patients with ankylosing spondylitis. On the one hand, it enables early diagnosis, saving the patient years of trial treatments and saving the healthcare system the cost of multiple diagnostic tests to try to explain the symptoms these patients present. On the other hand, it enables the rapid, objective evaluation of the response to therapy, thus making it possible to step up to a new, more aggressive therapy quickly and avoid treatments that are not very effective.