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Imaging in Axial Spondyloarthritis: What is Relevant for Diagnosis in Daily Practice?

  • Spondyloarthritis (M Khan and N Akkoc, Section Editors)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To explore how imaging may assist diagnosing axial spondyloarthritis in rheumatology practice.

Recent Findings

A diagnosis of axial spondyloarthritis is based on pattern recognition by synthesizing clinical, laboratory, and imaging findings. In health care settings providing low threshold access to advanced imaging, sacroiliac joint MRI is the preferred imaging modality in clinically suspected axial spondyloarthritis. In daily routine, the optimum protocol to assess suspected inflammatory back pain combines sacroiliac joint and spine MRI fitting a 30-min slot. Contextual assessment of concomitant structural and active MRI lesions is key to enhance diagnostic utility. In women with postpartum back pain suggestive of axial spondyloarthritis, recent reports advocate waiting 6–12 months after delivery before acquiring sacroiliac joint MRI. Major unmet needs are consistent MRI protocols, standardized training modules on how to evaluate axial MRI, and timely dissemination of imaging advances into mainstream practice both in rheumatology and in radiology.

Summary

In rheumatology practice, MRI has become indispensable to help diagnose early axial spondyloarthritis. However, major gaps in training and knowledge transfer to daily care need to be closed.

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Abbreviations

ASAS:

Assessment of SpondyloArthritis international Society

BME:

bone marrow edema

BMI:

body mass index

CRP:

C-reactive protein

CT:

computed tomography

HLA-B27:

human leucocyte antigen B27

MRI:

magnetic resonance imaging

SIJ:

sacroiliac joint

STIR:

short tau inversion recovery sequence

T1FS:

T1 fat-saturated sequence

T1SE:

T1 spin echo sequence

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Authors and Affiliations

  1. Rheumatology, Practice Buchsbaum, Schwertstrasse 9, 8200, Schaffhausen, Switzerland

    Ulrich Weber

  2. Department of Radiology, Aarhus University Hospital, Palle Juul-Jensen Boulevard 35, cross point, C 109 8200, Aarhus, Denmark

    Anne Grethe Jurik

  3. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard, 99 8200, Aarhus, Denmark

    Anne Grethe Jurik

  4. Institute of Regional Health Research, University of Southern Denmark, Campusvej, 55 5230, Odense M, Denmark

    Anne Grethe Jurik

  5. Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada

    Robert G. W. Lambert

  6. Medical Imaging Consultants, 202-11010 - 101 Street, Hys Centre, Edmonton, Alberta, T5H 4B9, Canada

    Robert G. W. Lambert

  7. Department of Medicine, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta, T6G 2R3, Canada

    Walter P. Maksymowych

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Weber, U., Jurik, A.G., Lambert, R.G.W. et al. Imaging in Axial Spondyloarthritis: What is Relevant for Diagnosis in Daily Practice?. Curr Rheumatol Rep 23, 66 (2021). https://doi.org/10.1007/s11926-021-01030-w

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