Three sagittal images of short-tau inversion recovery (STIR)-weighted magnetic resonance imaging (MRI), T1-weighted MRI, and computed tomography of the.

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Three sagittal images of short-tau inversion recovery (STIR)-weighted magnetic resonance imaging (MRI), T1-weighted MRI, and computed tomography of the lumbar spine in a 37-year-old-male patient with ankylosing spondylitis. Three sagittal images of short-tau inversion recovery (STIR)-weighted magnetic resonance imaging (MRI), T1-weighted MRI, and computed tomography of the lumbar spine in a 37-year-old-male patient with ankylosing spondylitis. The STIR image shows a corner inflammatory lesion5 in the anterosuperior corner of the first lumbar vertebra with bone marrow edema (BME) causing increased signal (bright on STIR). The BME does not quite extend into the corner, which has been eroded. The definition of erosion requires the loss of overlying cortex, and while this can be appreciated on the T1-weighted image, the erosion is most easily seen on computed tomography (CT). The CT scan reveals not only the “Romanus lesion” but also a “shiny corner” due to vertebral sclerosis and a tiny adjacent syndesmophyte — precisely as described by Romanus in 19522. Note that the syndesmophyte cannot be seen on the MRI scan. ROBERT G.W. LAMBERT J Rheumatol 2013;40:1791-1793 ©2013 by The Journal of Rheumatology