E1447. Imaging of the Spine in the Inflammatory Arthritis: The Role of CT and MRI
  1. Jing Chen; Penn State Health Milton S. Hershey Medical Center
  2. Einat Slonimsky; Penn State Health Milton S. Hershey Medical Center
  3. Sangam Kanekar; Penn State Health Milton S. Hershey Medical Center
  4. Puneet Kochar ; Penn State Health Milton S. Hershey Medical Center
Several types of arthritis commonly affect the spine. Arthritis is the common term used to describe pathological changes to joints and their associated structures, including bones, cartilage, and ligaments. Depending on whether the immune system is involved or not, arthritis can be categorized into two main subtypes: inflammatory and non-inflammatory. Osteoarthritis, non-inflammatory arthritis, is the most common and often affects the cervical spine and the lumbar spine. Ankylosing spondylitis is the most common inflammatory arthritis that principally affects the spine rather than other joints, while Rheumatoid arthritis is the most common type of inflammatory arthritis, affects mostly the limb joints but can also affect the cervical spine, causing neck pain and headache. CT or MRI are frequently used as primary investigations in the evaluation of back or neck pain, which may be due to inflammatory or non-inflammatory arthritis.

Educational Goals / Teaching Points
1. To classify and discuss the pathology and pathogenesis of the inflammatory and non-inflammatory arthritis. 2. To highlight the imaging findings and diagnostic pearls of the inflammatory and non-inflammatory arthritis on CT and MRI.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We retrospectively reviewed the imaging studies from our PACS system of 320 patients with the neck and or back pain with clinical diagnosis of spondyloarthritides, which forms the basis of this exhibit. All patients had undergone plain radiography addition to CT and /or MRI. In addition, 185 patients had a follow-up either CT or MRI. For easy understanding, this exhibit is classified under the following categories: 1. Inflammatory Arthritis: a) Seropositive: Adult Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, Lupus, scleroderma, vasculitis, and Sjogren’s disease b) Seronegative: Ankylosing Spondylitis, Psoriatic arthritis, reactive arthritis, and inflammatory bowel disease c) infectious arthritis, and d) crystal-induced: CPPD Gout, Longus Coli Calcific Tendinitis e) Miscellaneous: Neurogenic (Charcot) Arthropathy, Hemodialysis Spondyloarthropathy. 2. Non-inflammatory/Degenerative Arthritis: a) Body and disc: Disc and Endplate Degenerative Changes, Schmorl’s Node, Scheuermann Disease DISH, Periodontoid Pseudotumor b) Posterior elements and ligaments: Cervical Facet Arthropathy, Lumbar Facet Arthropathy, Facet Joint Synovial Cyst, BaastrupDisease, BertolottiSyndrome, OPLL, Ossification Ligamentum Flavum

Differentiating inflammatory from non-inflammatory arthritis especially in the early stages is of vital importance to slow the progress and avoid the long-term spinal complications. Due to nonspecific clinical presentations such as neck and back pain, MRI and CT are increasingly recommended as an initial examination. In this exhibit, we highlight the early imaging features of both inflammatory and non-inflammatory arthritis, focusing particularly on the early changes in inflammatory arthritis.