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Modic Changes — SCE Rheumatology MCQ

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HardMusculoskeletal ImagingModic ChangesSCE Rheumatology

A 40-year-old man with chronic low back pain has an MRI showing Modic type 1 changes at L4/L5. What do Modic type 1 changes represent?

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Correct answer: ABone marrow oedema and inflammation (active process)

The best answer is “Bone marrow oedema and inflammation (active process)”. The full clinical pattern is most consistent with Bone marrow oedema and inflammation (active process); competing diagnoses share isolated features but not the decisive combination described. The remaining choices—“Fatty marrow replacement (stable disease), after safety review”, “Tumour infiltration, after specialist assessment, after specialist assessment”, “Normal finding, with clinical reassessment, with clinical reassessment”, “Sclerosis (end-stage disease), within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: British Society for Rheumatology clinical guidelines: https://academic.oup.com/rheumatology/pages/clinical-guidelines