case_images: PMC11783928_01
case_images: Pelvis MRI at disease onset. a The T2w sequence documents some areas of altered signal referable to spongious edema, some of them with symmetrical distribution, blurred, involving the limiting joints of the sacro-iliac synchondroses and more cranially the iliac crests, others with asymmetrical distribution, in the presence of conspicuous edematous alteration of the pre-symphyseal side of the right ileo- and ischio-pubic branches that on the opposite side seems only veiledly hinted at. b, c Changes are accompanied by discrete contrastographic impregnation in the CE-FS T1w sequence, particularly that located at the pubic site on the right, where concomitant periosteal reaction is seen, with traces of initial edema of the adjacent adductor muscle bundles
case_images: 13052_2025_1842_Fig1_HTML.jpg
case_images: PMC11783928_01_13052_2025_1842_Fig1_HTML.jpg
case_images: Fig1
case_images: The exam did not find out joint effusion, nor lithic bone alterations (Figs. 1, 2).
case_images: Spine MR at disease onset. At the level of the lumbar vertebrae, symmetrical alterations with similar pre- (a STIR) and post-contrastographic (b T1w CE-FS) signal are reported at the level of the transverse processes of L5 and, more nuanced, at the antero-superior edge of L1 in the right paramedian location and at the lower portion of the soma of L2
case_images: 13052_2025_1842_Fig2_HTML.jpg
case_images: PMC11783928_01_13052_2025_1842_Fig2_HTML.jpg
case_images: Fig2
case_images: The exam did not find out joint effusion, nor lithic bone alterations (Figs. 1, 2).
case_images: a, b, c WBMR four months after the gluten-free diet start. Almost complete resolution of the alterations described at the previous MRI examination. In particular, alterations previously located at the sacral flaps, iliac side of the synchondroses, iliac crests, right pubic spine, chondrocostal and sternal joints, distal clavicles and proximal humeri, distal metaphyses of radius and ulna, and acetabular roofs are no longer recognizable. Clear reduction of alterations at distal femoral and proximal tibial metaphyseal regions, where only a tinge of signal hyperintensity in STIR accompanied by a veiled T1 hypointensity remains, in the absence of significant alterations in diffusion sequences; at this level, the previously reported edematous perischelectric soft tissue alterations are no longer evident
case_images: 13052_2025_1842_Fig3_HTML.jpg
case_images: PMC11783928_01_13052_2025_1842_Fig3_HTML.jpg
case_images: Fig3
case_images: The WBMR showed complete disease healing, with disappearance of all the bone lesions previously described (Fig. 3). 