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MRI in pediatric sacroiliitis, what radiologists should know

  • Musculoskeletal imaging
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Abstract

MRI is used for early detection of inflammation of sacroiliac joints as it shows active lesions of sacroiliitis long before radiographs show damage to the sacroiliac joints. Early diagnosis of arthritis allows early treatment of inflammation and can help delay disease progression and prevent irreversible damage. Also, early identification of axial involvement in juvenile spondyloarthropathy is crucial, as treatment options are different than for peripheral juvenile spondyloarthropathy. In general, standard sequences used in adults are also applied to children. However, interpreting MR images of pediatric sacroiliac joints is more challenging than in adults, because of normal physiological changes during skeletal maturation, which can simulate disease on MR images. Furthermore, classical definitions of sacroiliitis used in adults, for both active inflammatory and structural lesions, can be difficult to extrapolate to children. The development of reliable pediatric-specific definitions for sacroiliitis is still in active study. Understanding both normal and pathological signal changes in children is important to distinguish physiologic findings from disease and to make a correct diagnosis. In this review, the main imaging characteristics of sacroiliitis on MRI in children and its frequent pitfalls will be illustrated, while also citing some discussion points regarding the scan protocol.

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Correspondence to Nele Herregods.

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This study was approved by the institutional ethics committee of Ghent University Hospital, Belgium. Written informed consent was achieved by all children and parents.

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Dr. Jaremko is supported by a Canada CIFAR AI Chair and Medical Imaging Consultants. All other authors declare that they have no conflict of interest.

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Herregods, N., Anisau, A., Schiettecatte, E. et al. MRI in pediatric sacroiliitis, what radiologists should know. Pediatr Radiol 53, 1576–1586 (2023). https://doi.org/10.1007/s00247-023-05602-z

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