J Rheum Dis.  2021 Jul;28(3):159-164. 10.4078/jrd.2021.28.3.159.

Anterior Chest Wall Involvement in Spondyloarthritis Patients as Detected by Magnetic Resonance Imaging: A Case Series and Literature Review

• Lee TH
• Lee Cm
• Kim TH
• Lee S

• KMID: 2516952
• DOI: http://doi.org/10.4078/jrd.2021.28.3.159

Abstract

Magnetic resonance imaging (MRI) plays an important role in diagnosing and classifying axial spondyloarthritis (SpA) and is also useful for appropriate evaluation of disease status owing to its ability to detect inflammation early and reveal structural changes. However, dedicated MRI for the anterior chest wall (ACW) is not routinely considered despite relatively frequent presence of ACW lesions. To date, no study has investigated the imaging findings and clinical features of ACW involvement in Korean SpA patients. Thus, we aimed to show ACW involvement in SpA patients using ACW lesions found by MRI. We describe 20 cases of ACW involvement in which MRI-detected manubriosternal joint lesions. The lesion types included subchondral bone marrow edema, marginal or central bone erosions, subchondral fat infiltration or deposition, and ankylosis, with erosions being the most prevalent finding. We also provide the literature review results describing MRI findings of ACW lesions in SpA patients.

Keyword

Anterior chest wall; Manubriosternal joint; Spondyloarthritis; Magnetic resonance imaging

Figure

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  Figure 1 Sagittal MR images from Dixon sequence of a 40-year-old female AS patient. The patient underwent thoracic spine MRI because of ACW pain and worsening back pain during TNF inhibitor therapy. T1-weighted (A) and T2-weighted water-only (B) images of the ACW included in the field of view for thoracic spine MRI. The images show bony erosion (arrow) and periarticular fat deposition (arrowheads) at the MSJ. MRI: magnetic resonance imaging, AS: ankylosing spondylitis, TNF: tumor necrosis factor, ACW: anterior chest wall, MSJ: manubriosternal joint.

• 

  Figure 2 Sagittal MR images of a 53-year-old male patient with nr-axSpA, including T1-weighted (A) and T2-weighted STIR (B) images. Whole spine MRI was acquired following a clinical trial protocol in which the patient was enrolled. The patient did not experience ACW pain at the time of MRI. Bony erosion (arrow) and subchondral bone marrow edema (arrowheads) were observed at the MSJ. MRI: magnetic resonance imaging, nr-axSpA: non-radiographic axial spondyloarthritis, STIR: short tau inversion recovery, ACW: anterior chest wall, MSJ: manubriosternal joint.

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  Figure 3 Sagittal T1-weighted (A) and T2-weighted STIR (B) images of a 52-year-old female AS patient, demonstrating ankylosis of the MSJ (arrows). The patient reported no ACW pain at the time of MRI. STIR: short tau inversion recovery, AS: ankylosing spondylotis, MSJ: manubriosternal joint, ACW: anterior chest wall, MRI: magnetic resonance imaging.

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