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SIJ - differentials
OCI / postpartum changes
Strain-related SIJ changes
Degenerative / DISH changes
Infectious sacroiliitis
Inflammatory conditions
Metabolic disorders
Spine - differentials
Degenerative changes
Infectious spondylitis
Degenerative spinal changes

Degenerative spinal changes are frequent causes of back pain. The findings by MRI can vary considerably and there can be subchondral edematous changes as well as fat deposition in accordance with the description of Modic et. al., doi:10.1148/radiology.166.1.3336678.

As part of disk degeneration there can be three different types of endplate changes

Modic type I: represents bone marrow edema with low signal on T1 and high signal on T2 and STIR images.

Modic type II: represents a stage where the changes have converted to fat deposition in the bone marrow with high signal on T1, iso-high signal on T2 and low signal on STIR/T2FS images.

Modic type III: represents subchondral osseous sclerosis with low signal on T1, T2 as well as STIR.

There can be a mixture of the three types, but a common feature for all types is a frequent location along the vertebral plate, often involving the entire subchondral area in contrast to axSpA changes which typically involve the vertebral corners. However, degenerative changes can sometimes predominate at vertebral corners and can then be difficult to differentiate from SpA changes. Besides, patients with axSpA can have concomitant degenerative changes.

Examples of Modic changes are shown below.

MRI of the entire spine, sagittal T1 and STIR image, in a young patient with inflammatory back pain indicating possible axSpA. There is reduced height and water content corresponding to a lumbar disk with concomitant pronounced subchondral edema encompassing the entire subchondral areas, consistent with Modic type 1 changes (arrows). There is in addition prolapse of the disk, best visualized on the axial T2-weighted slice (open arrows) seen to the right accompanied by a sagittal image showing the image location.

MRI of the lumbar spine, sagittal T1, T2 and T2FS image, in a middle-aged person with low back pain. There is generally reduced water content corresponding to the lumbar disks and at the lowest intervertebral space an accompanying mixture of Modic type 1 and type 2 changes. A clear delineation of the two types is best obtained by a combination of the T1 image, showing the fat deposition anteriorly (arrows), and the STIR image showing the subchondral edema posteriorly (open arrows).

Modic changes with a corner predominance. There is a mixture of Modic type 1 and type 2. The edema predominates anteriorly, but with visible extension posteriorly to the posterior part of the vertebra. This is less obvious corresponding to the fat deposition (arrow) although there may be a slim area of fat deposition extending posteriorly.

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