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<v ->Now, one of the findings that occurs in the spine

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in ankylosing spondylitis is known as the Romanus lesion.

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If you have trouble remembering it, just remember R.

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Romanus for R, rim of the vertebral body.

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Because this affects the corners of the vertebral body

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and is related to an osteitis, an inflammation,

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where the anular fibers attach to bone.

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So what you will see radiographically is known

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as the shiny corner sign.

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It's associated with bone proliferation

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that may produce squaring

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of the anterior surface of the vertebral body.

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And over time is associated with syndesmofied formation.

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Here you can see that shiny corner sign

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perhaps a hazy syndesmofied is forming

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and the straightening

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and sometimes even convexity of

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the intervertebral surface.

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This is the Romanus lesion.

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Here you can see Romanus lesion on CT.

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You can see on the coronal CT the sycreoid joints

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are fused.

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There's ischial enthesopathy as well.

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So that is the Romanus lesion.

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Now, when you examine the Romanus lesion

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with MR in the early stages,

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the finding again,

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just as it will with sacroiliitis is marrow edema.

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So typically with the Romanus lesion

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the marrow edema can occur

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at the corners of the vertebral body.

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Associated with some of the other abnormalities

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I just mentioned.

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Marrow edema in the early stages.

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What happens later on is exactly what happens

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with the sacroiliac joint.

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And that is fatty metaplasia occurs

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in the area of the edema.

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And so what it produces known

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as a fatty corner.

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Here's an example.

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Here's another example.

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You can see them here.

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They are now Romanus lesions that have gone

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on to chronicity.

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So it's not surprising that there are articles

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that suggest all you've gotta do is

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find these fatty corners.

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As you can see in this example.

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Taken from this article.

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Count them up,

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see how many there are and the higher the number,

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the more likely you're dealing with

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axial spondyloarthropathy.

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You can see the number doesn't have to be too high

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for you to get a fairly good sensitivity and specificity.

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I don't count them, but perhaps others who

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are listening do count these fatty corners.