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The fatty Romanus lesion: a non-inflammatory spinal MRI lesion specific for axial spondyloarthropathy

A N Bennett1, A Rehman, E M A Hensor

  • 1Academic Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, Chapel Allerton Hospital, Chapel Town Rd, Leeds LS7 4SA, UK.

Annals of the Rheumatic Diseases
|August 12, 2009
PubMed
Abstract

Insights

Fatty Romanus lesions (FRLs) are a useful imaging feature for diagnosing early axial spondyloarthropathy (axial-SpA), especially when other MRI signs are absent. These vertebral corner changes aid in identifying axial-SpA in patients with chronic back pain.

Area of Science:

  • Radiology
  • Rheumatology
  • Medical Imaging

Background:

  • Fatty changes at vertebral corners on MRI have been observed in ankylosing spondylitis.
  • The distribution and specificity of these fatty lesions for early axial spondyloarthropathy (axial-SpA) remain undetermined.

Purpose of the Study:

  • To evaluate the diagnostic value of fatty Romanus lesions (FRLs) for identifying axial-SpA in individuals experiencing chronic back pain.
  • To determine the utility of FRLs as an imaging biomarker for axial-SpA.

Main Methods:

  • 174 patients with back pain and 11 controls underwent axial-skeleton TI SE and fat-suppressed MRI.
  • MRI scans were analyzed for lesions, including FRLs, by blinded assessors.
  • Imaging diagnoses based on MRI findings were compared against the treating physician's diagnosis.

Main Results:

  • Fatty Romanus lesions (FRLs) were identified in 31% of spondyloarthropathy patients, significantly more than in degenerative arthritis, malignancy, or control groups.
  • The majority of FRLs in spondyloarthropathy (60%) were located in the thoracic spine.
  • FRLs demonstrated significant diagnostic utility for SpA (LR=4.7), increasing with lesion count (LR=12.6). Notably, 25% of SpA patients with FRLs showed no bone edema on MRI.

Conclusions:

  • Fatty Romanus lesions (FRLs) are established as a diagnostic imaging feature indicative of axial-SpA.
  • FRLs can be valuable for diagnosing axial-SpA, particularly when inflammatory changes are not evident on fat-suppression MRI or when radiography is normal.

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