Objective. Andersson lesions (ALs) associated with long-standing ankylosing spondylitis (AS) is difficult to detect early due to vague clinical presentations, and the diagnosis is mainly based on radiological findings; however, most previous clinical and radiological studies of ALs enrolled only small sample sizes with limited imaging methods. This study reviewed the largest series of ALs patients, aimed to characterize ALs according to different imaging modalities of plain radiograph, CT and MRI, and to determine the clinical relevance of these radiological features.