title: Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis.
abstract: Ankylosing spondylitis (AS) is a chronic inflammatory disease which affects primarily the sacroiliac joints and the spine. In patients with active disease, magnetic resonance imaging (MRI) of the spine shows areas of bone marrow edema, the histopathological equivalent of which is unknown. In this study we correlate inflammation in the spine of patients with AS as revealed by histological examination with bone marrow edema as detected by MRI. We have compared the histopathological findings of zygapophyseal joints from 8 patients with AS (age: 30 to 64, disease duration 7 to 33 years) undergoing spinal surgery with findings in MRI. For histopathological analysis, we quantified infiltrates of CD3+, CD4+ and CD8+ T cells as well as CD20+ B cells immunohistochemically. Bone marrow edema was evaluated in hematoxylin and eosin stained sections and quantified as the percentage of the bone marrow area involved. All patients with AS showed interstitial mononuclear cell infiltrates and various degrees of bone marrow edema (range from 10% to 60%) in histopathological analysis. However, in only three of eight patients histopathological inflammation and edema in the zygapophyseal joints correlated with bone marrow edema in zygapophyseal joints of the lumbar spine as detected by MRI. Interestingly, two of these patients showed the highest histological score for bone marrow edema (60%). This first study correlating histopathological changes in the spine of patients with AS with findings in MRI scans suggests that a substantial degree of bone marrow inflammation and edema is necessary to be detected by MRI.
authors.affiliation: Charité Berlin, Campus Benjamin Franklin, Department of Gastroenterology, Infectiology and Rheumatology, Hindenburgdamm 30, 12200 Berlin, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Appel
authors.forename: Christoph
authors.initials: C
authors.lastname: Loddenkemper
authors.forename: Zarko
authors.initials: Z
authors.lastname: Grozdanovic
authors.forename: Harald
authors.initials: H
authors.lastname: Ebhardt
authors.forename: Marc
authors.initials: M
authors.lastname: Dreimann
authors.forename: Axel
authors.initials: A
authors.lastname: Hempfing
authors.forename: Harald
authors.initials: H
authors.lastname: Stein
authors.forename: Peter
authors.initials: P
authors.lastname: Metz-Stavenhagen
authors.forename: Martin
authors.initials: M
authors.lastname: Rudwaleit
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
mesh_terms: D000328:Adult; D018951:Antigens, CD20 / Q000378:metabolism; D001402:B-Lymphocytes / Q000378:metabolism / Q000473:pathology; D001853:Bone Marrow / Q000098:blood supply / Q000276:immunology / Q000473:pathology*; D017252:CD3 Complex / Q000378:metabolism; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism / Q000473:pathology; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism / Q000473:pathology; D004487:Edema / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D013167:Spondylitis, Ankylosing / Q000276:immunology / Q000473:pathology*; D021801:Zygapophyseal Joint / Q000098:blood supply / Q000276:immunology / Q000473:pathology*
chemical_list: D018951:Antigens, CD20; D017252:CD3 Complex