Imaging in axial spondyloarthritis: Changing concepts and thresholds

Ulrich Weber*, Xenofon Baraliakos

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Imaging is key to recognition of axial spondyloarthritis (SpA) because clinical and laboratory examinations have limited diagnostic utility. Only MRI can capture both inflammation and bone remodeling by simultaneous depiction of active and structural lesions and their anatomic location. Bone marrow edema of limited extent on the sacroiliac joint (SIJ) MRI is often nonspecific and should be interpreted along with the clinical context. Contextual interpretation of the SIJ lesion signature viewed simultaneously on fluid- and fat-sensitive MRI sequences enhances confidence in the recognition of disease. A critical re-appraisal of using pelvic radiographs in clinically suspected early spondyloarthritis is warranted because of substantial limitations. In health care settings with low threshold access to advanced imaging, MRI is the preferred modality in early SpA. CT has recently advanced spinal outcome research, but substantial radiation exposure in young patients with spondyloarthritis and limited evidence on its relevance in practice do not advocate its use in daily routine.

Original languageEnglish
JournalBest Practice and Research: Clinical Rheumatology
Volume32
Issue number3
Pages (from-to)342-356
ISSN1521-6942
DOIs
Publication statusPublished - Jun 2018

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Sacroiliac Joint
Fats
Outcome Assessment (Health Care)
Delivery of Health Care

Keywords

  • Ankylosing spondylitis
  • Bone marrow edema
  • Classification
  • Computed tomography
  • Diagnosis
  • Magnetic resonance imaging
  • Radiography
  • Spondyloarthritis
  • Structural lesions

Cite this

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title = "Imaging in axial spondyloarthritis: Changing concepts and thresholds",
abstract = "Imaging is key to recognition of axial spondyloarthritis (SpA) because clinical and laboratory examinations have limited diagnostic utility. Only MRI can capture both inflammation and bone remodeling by simultaneous depiction of active and structural lesions and their anatomic location. Bone marrow edema of limited extent on the sacroiliac joint (SIJ) MRI is often nonspecific and should be interpreted along with the clinical context. Contextual interpretation of the SIJ lesion signature viewed simultaneously on fluid- and fat-sensitive MRI sequences enhances confidence in the recognition of disease. A critical re-appraisal of using pelvic radiographs in clinically suspected early spondyloarthritis is warranted because of substantial limitations. In health care settings with low threshold access to advanced imaging, MRI is the preferred modality in early SpA. CT has recently advanced spinal outcome research, but substantial radiation exposure in young patients with spondyloarthritis and limited evidence on its relevance in practice do not advocate its use in daily routine.",
keywords = "Ankylosing spondylitis, Bone marrow edema, Classification, Computed tomography, Diagnosis, Magnetic resonance imaging, Radiography, Spondyloarthritis, Structural lesions",
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Imaging in axial spondyloarthritis : Changing concepts and thresholds. / Weber, Ulrich; Baraliakos, Xenofon.

In: Best Practice and Research: Clinical Rheumatology, Vol. 32, No. 3, 06.2018, p. 342-356.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Imaging in axial spondyloarthritis

T2 - Changing concepts and thresholds

AU - Weber, Ulrich

AU - Baraliakos, Xenofon

PY - 2018/6

Y1 - 2018/6

N2 - Imaging is key to recognition of axial spondyloarthritis (SpA) because clinical and laboratory examinations have limited diagnostic utility. Only MRI can capture both inflammation and bone remodeling by simultaneous depiction of active and structural lesions and their anatomic location. Bone marrow edema of limited extent on the sacroiliac joint (SIJ) MRI is often nonspecific and should be interpreted along with the clinical context. Contextual interpretation of the SIJ lesion signature viewed simultaneously on fluid- and fat-sensitive MRI sequences enhances confidence in the recognition of disease. A critical re-appraisal of using pelvic radiographs in clinically suspected early spondyloarthritis is warranted because of substantial limitations. In health care settings with low threshold access to advanced imaging, MRI is the preferred modality in early SpA. CT has recently advanced spinal outcome research, but substantial radiation exposure in young patients with spondyloarthritis and limited evidence on its relevance in practice do not advocate its use in daily routine.

AB - Imaging is key to recognition of axial spondyloarthritis (SpA) because clinical and laboratory examinations have limited diagnostic utility. Only MRI can capture both inflammation and bone remodeling by simultaneous depiction of active and structural lesions and their anatomic location. Bone marrow edema of limited extent on the sacroiliac joint (SIJ) MRI is often nonspecific and should be interpreted along with the clinical context. Contextual interpretation of the SIJ lesion signature viewed simultaneously on fluid- and fat-sensitive MRI sequences enhances confidence in the recognition of disease. A critical re-appraisal of using pelvic radiographs in clinically suspected early spondyloarthritis is warranted because of substantial limitations. In health care settings with low threshold access to advanced imaging, MRI is the preferred modality in early SpA. CT has recently advanced spinal outcome research, but substantial radiation exposure in young patients with spondyloarthritis and limited evidence on its relevance in practice do not advocate its use in daily routine.

KW - Ankylosing spondylitis

KW - Bone marrow edema

KW - Classification

KW - Computed tomography

KW - Diagnosis

KW - Magnetic resonance imaging

KW - Radiography

KW - Spondyloarthritis

KW - Structural lesions

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JO - Best Practice & Research: Clinical Rheumatology

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ER -