Magnetic resonance imaging assessment in patients with axial spondyloarthritis: development of checklists for use in clinical practice


The objective of our study was to standardize magnetic resonance imaging (MRI) assessment of spine and sacroiliac joints in patients with axial spondyloarthritis (axSpA) and/or inflammatory spinal pain, by creating checklists and templates based on the opinions of rheumatologists and radiologists. A scientific committee developed a series of questionnaires with multiple items regarding MRI in patients with axial inflammatory pain and/or axSpA. Then an expert panel of rheumatologists and radiologists rated all items in a 9-point Likert scale. Finally, the scientific committee and the expert panel met to create the definitive documents. Several definitive checklists and templates were generated for rheumatologist-requested MRI and for radiologist-requested MRI reports of sacroiliac joint and spinal examinations. A technical requirement protocol was also agreed on. Our results could be useful in increasing understanding between rheumatologists and radiologists regarding MRI in axSpA diagnosis and follow-up.

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  1. 1.

    Spanish Society of Rheumatology (2017) Espoguía Working Group. Clinical practice guidelines for the management of axial spondyloarthritis and psoriasic arthritis. Update.ón-2017_DEF_web.pdf. Accessed 18 Jun 2019

  2. 2.

    López-Medina C, Garrido-Castro JL, Castro-Jiménez J et al (2018) Evaluation of quality of life in patients with axial spondyloarthritis and its association with disease activity, functionality, mobility, and structural damage. Clin Rheumatol 37:1581–1588.

    Article  PubMed  Google Scholar 

  3. 3.

    Rudwaleit M, van der Heijde D, Landewé R et al (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Lambert RGW, Bakker PAC, van der Heijde D et al (2016) Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis 75:1958–1963.

    Article  PubMed  Google Scholar 

  5. 5.

    Uson J, Loza E, Möller I et al (2018) Recommendations for the use of ultrasound and magnetic resonance in patients with spondyloarthritis, including psoriatic arthritis, and patients with juvenile idiopathic arthritis. Reumatol Clín 14:27–35.

    Article  PubMed  Google Scholar 

  6. 6.

    Mandl P, Navarro-Compán V, Terslev L et al (2015) EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 74:1327–1339.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    van der Heijde D, Ramiro S, Landewé R et al (2017) 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 76:978–991.

    Article  PubMed  Google Scholar 

  8. 8.

    Lukas C, Cyteval C, Dougados M, Weber U (2018) MRI for diagnosis of axial spondyloarthritis: major advance with critical limitations ‘Not everything that glisters is gold (standard)’. RMD Open 4:e000586.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Almodóvar R, Zarco P, Loza E, Bueno Á (2019) Evaluation of a multidisciplinary training program in magnetic resonance imaging of patients with axial spondyloarthritis: PROGRESSES project. Radiologia 61:94–98.

    Article  PubMed  Google Scholar 

  10. 10.

    Schueller-Weidekamm C, Mascarenhas V, Sudol-Szopinska I et al (2014) Imaging and interpretation of axial spondylarthritis: the radiologist’s perspective—consensus of the arthritis subcommittee of the ESSR. Semin Musculoskelet Radiol 18:265–279.

    Article  PubMed  Google Scholar 

  11. 11.

    Schueller-Weidekamm C, Mascarenhas V, Sudol-Szopinska I et al (2014) Imaging and interpretation of axial spondylarthritis: the radiologist’s perspective—consensus of the arthritis subcommittee of the ESSR. Semin Musculoskelet Radiol 18:523–524.

    Article  Google Scholar 

  12. 12.

    Bloem JL, Reijnierse M, Huizinga TWJ, van der Helm-van Mil AHM (2018) MR signal intensity: staying on the bright side in MR image interpretation. RMD Open 4:e000728.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Bennett AN, Marzo-Ortega H, Kaur-Papadakis D et al (2017) The use of magnetic resonance imaging in axial spondyloarthritis: time to bridge the gap between radiologists and rheumatologists. J Rheumatol 44:780–785.

    Article  PubMed  Google Scholar 

  14. 14.

    Teh J, Østergaard M (2017) What the rheumatologist is looking for and what the radiologist should know in imaging for rheumatoid arthritis. Radiol Clin North Am 55:905–916.

    Article  PubMed  Google Scholar 

  15. 15.

    Reijnierse M, Helm-Mil A, Eshed I, Schueller-Weidekamm C (2018) Magnetic resonance imaging of rheumatoid arthritis: peripheral joints and spine. Semin Musculoskelet Radiol 22:127–146.

    Article  PubMed  Google Scholar 

  16. 16.

    Malattia C, Tzaribachev N, van den Berg JM, Magni-Manzoni S (2018) Juvenile idiopathic arthritis—the role of imaging from a rheumatologist’s perspective. Pediatr Radiol 48:785–791.

    Article  PubMed  Google Scholar 

  17. 17.

    Sudoł-Szopińska I, Urbanik A, Wojciechowski W et al (2015) Polish Medical Society of Radiology and Polish Society of rheumatology recommendations for magnetic resonance imaging of musculoskeletal disorders in rheumatology. Pol J Radiol 80:259–265.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Narváez JA, Bueno Horcajadas A, de Miguel Mendieta E, Sanz Sanz J (2015) Guidelines for magnetic resonance imaging in axial spondyloarthritis: a Delphi study. Radiologia 57:512–522.

    Article  PubMed  Google Scholar 

  19. 19.

    van der Heijde D, Sieper J, Elewaut D et al (2014) Referral patterns, diagnosis, and disease management of patients with axial spondyloarthritis. J Clin Rheumatol 20:411–417.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Tant L, Delmotte N, Van den Enden M et al (2017) High prevalence of undiagnosed axial spondyloarthritis in patients with chronic low back pain consulting non-rheumatologist specialists in Belgium: SUSPECT study. Rheumatol Ther 4:121–132.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Masson Behar V, Dougados M, Etcheto A et al (2017) Diagnostic delay in axial spondyloarthritis: a cross-sectional study of 432 patients. Jt Bone Spine 84:467–471.

    Article  Google Scholar 

  22. 22.

    Collantes E, Zarco P, Muñoz E et al (2007) Disease pattern of spondyloarthropathies in Spain: description of the first national registry (REGISPONSER) extended report. Rheumatology 46:1309–1315.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Rudwaleit M (2010) New approaches to diagnosis and classification of axial and peripheral spondyloarthritis. Curr Opin Rheumatol 22:375–380.

    Article  PubMed  Google Scholar 

  24. 24.

    Seo MR, Baek HL, Yoon HH et al (2015) Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis. Clin Rheumatol 34:1397–1405.

    Article  PubMed  Google Scholar 

  25. 25.

    Michelsen B, Fiane R, Diamantopoulos AP et al (2015) A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. PLoS One 10:e0123582.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Strand V, Singh JA (2017) Patient burden of axial spondyloarthritis. JCR J Clin Rheumatol 23:383–391.

    Article  PubMed  Google Scholar 

  27. 27.

    Khmelinskii N, Regel A, Baraliakos X (2018) The role of imaging in diagnosing axial spondyloarthritis. Front Med 5:106.

    Article  Google Scholar 

  28. 28.

    Leone A, Marino M, Dell’Atti C et al (2016) Spinal fractures in patients with ankylosing spondylitis. Rheumatol Int 36:1335–1346.

    Article  PubMed  Google Scholar 

  29. 29.

    Rustagi T, Drazin D, Oner C et al (2017) Fractures in spinal ankylosing disorders. J Orthop Trauma 31:S57–S74.

    Article  PubMed  Google Scholar 

  30. 30.

    Hammoudeh M, Abdulaziz S, Alosaimi H et al (2016) Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: an expert consensus. J Int Med Res 44:216–230.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Ward MM, Deodhar A, Gensler LS et al (2019) 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol.

    Article  PubMed  Google Scholar 

  32. 32.

    Rennie W, Jans L, Jurik A et al (2018) Anterior chest wall in axial spondyloarthritis: imaging, interpretation, and differential diagnosis. Semin Musculoskelet Radiol 22:197–206.

    Article  PubMed  Google Scholar 

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The authors did not receive any financial or material support for the study or any technical assistance in writing the manuscript. The authors have no financial relationship that may involve a conflict of interest.


The authors did not receive any financial or material support for the study.

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All authors, particularly RA, AB and PZ, contributed to the study conception and design as well as to material preparation, data collection, and analysis. RA, AB, and PZ wrote the first draft of the manuscript; then, all authors commented on previous versions of the manuscript, revising it critically for important intellectual content. All authors read and approved the final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work have been appropriately investigated and resolved.

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Correspondence to Raquel Almodóvar.

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Almodóvar, R., Bueno, Á., Batlle, E. et al. Magnetic resonance imaging assessment in patients with axial spondyloarthritis: development of checklists for use in clinical practice. Rheumatol Int 39, 2119–2127 (2019).

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  • Ankylosing spondylitis
  • Magnetic resonance imaging
  • Rheumatologists
  • Radiologists
  • Surveys and questionnaires