Use of Quantitative Vertebral Bone Marrow Fat Fraction to Assess Disease Activity and Chronicity in Patients with Ankylosing Spondylitis

Objective: We quantitatively measured the fat fraction (FF) in the vertebrae of patients with ankylosing spondylitis (AS) using magnetic resonance imaging (MRI) and investigated the role of FF as an indicator of both active inflammation and chronicity. Materials and Methods: A total of 52 patients with AS who underwent spinal MRI were retrospectively evaluated. The FF values of the anterosuperior and anteroinferior corners of the bone marrow in the L1-S1 spine were assessed using the modified Dixon technique. AS activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), AS Disease Activity Score (ASDAS), and serum inflammatory marker levels. AS disease chronicity was assessed by AS disease duration and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Univariable and multivariable regression analyses were conducted to investigate the correlation between FF and other clinical characteristics. Results: The mean FF +/- standard deviation of the total lumbar spine was 43.0% +/- 11.3%. At univariable analysis, spinal FF showed significant negative correlation with BASDAI (beta = -0.474, p = 0.002) and ASDAS with C-reactive protein (ASDAS-CRP; beta = -0.478, p = 0.002) and a significant positive correlation with AS disease duration (beta = 0.440, p = 0.001). After adjusting for patient age, sex, and total mSASSS score, spinal FF remained significantly negatively correlated with BASDAI (beta = -0.543, p < 0.001), ASDAS-CRP (beta = -0.568, p < 0.001), and ASDAS with erythrocyte sedimentation rate (beta = -0.533, p = 0.001). Spinal FF was significantly Lower in patients with very high disease activity (ASDAS-CRP > 3.5) than in those with only high disease activity (2.1 <= ASDAS-CRP <= 3.5) (p = 0.010). Conclusion: Spinal FF may help assess both AS disease activity and chronicity.

Automated summary

Quantitative measurement of fat fraction in the vertebrae of AS patients using MRI can help assess both disease activity and chronicity, which remains significantly correlated even after adjusting for patient age, sex, and other factors.