Magnetic resonance imaging (MRI) represents the gold standard imaging technique in the diagnosis of spondyloarthritis, in both early and late disease stages. In particular, MRI is the only technique that can detect bone marrow edema.
Conventional radiography can only detect chronic bony changes (i.e., erosions, osteosclerosis, syndesmophytes) in the late stage of spondyloarthritis.
Computed tomography (CT) allows a better morphological analysis of the bone (e.g., in case of small erosions) but it does not detect bone edema and uses more radiation, so its use is limited.
It is mandatory to use a proper MRI study protocol, given that “standard” examinations do not always allow a correct diagnosis.
In particular, an efficient spinal imaging protocol must comprise fat-suppressed T2-weighted sequences, with fat saturation technique or STIR sequences, in order to clearly visualize hyperintensity corresponding to edematous lesions.
In the same way, the administration of contrast medium, when indicated, must be followed by T1-weighted sequences with fat saturation, in order to clearly visualize the active inflammation.
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