Advances and Challenges in Spondyloarthritis Imaging for Diagnosis and Assessment of Disease

Abstract

In recent years there has been an increased focus on use of imaging for diagnosis and assessment of spondyloarthritis (SpA). Magnetic resonance imaging (MRI) has attracted particular interest for its potential to improve diagnostic certainty for early, non-radiographic disease and to assist clinical decision-making. This report summarizes recent developments toward definition of positive sacroiliac joint and spine MRIs for SpA, with erosion as the major determinant for disease classification. The report also highlights recent SpA imaging work relevant to daily practice, focusing on limitations and challenges of SpA imaging and, in particular, on unsolved practical difficulties of using MRI in SpA. Recent data suggest that SpA imaging in daily practice may not be confined to identification and assessment of disease; it may also become essential for monitoring, clinical decision making, and selecting the most appropriate treatment for patients with SpA. Improved use of imaging may have much potential to enable better management of SpA.

Diagnosis and Management of Late-Onset Spondyloarthritis: Implications of Treat-to-Target Recommendations

“…In the same way, fatty deposition at several vertebral corners orientated towards the diagnosis of axial SpA, again in younger adults [26,27]. Altogether, the different studies evaluating SIJ MRI in SpA yielded a sensitivity of between 60 and 90 % and a specificity between 70 and 95 % for the diagnosis of axial SpA [7] while spine MRI performed less well: sensitivity ranged from 30 to 60 % and specificity from 60 to 90 % [26,27]. It is noteworthy that the clinical utility of MRI for the assessment of SIJ inflammation was evaluated in young patients with AS, inflammatory back pain of recent onset, and mechanical back pain, and healthy controls, with the subjects studied generally aged under 45 years.…”

“…In addition, the modified New York criteria do not take into account the full clinical spectrum of SpA. MRI has emerged as an important imaging tool for the early detection of acute inflammation of the SIJ and/or the spine in patients with SpA [7]. In addition, it has been suggested that patients presenting with chronic inflammatory back pain before the age of 45 years are considered to have axial SpA, regardless of whether radiographic sacroiliitis is present or absent.…”

“…The validity of such criteria in the elderly is thus questionable. In the same way, magnetic resonance imaging (MRI) has emerged as an important imaging tool for the early detection of acute inflammation of the SIJ and/or spine in patients with SpA [7]. Sacroiliitis as detected by MRI is now included in the criteria for the classification of axial SpA.…”

Top-Ten Tips for Effective Imaging of Axial Spondyloarthritis

“…4 and 5). 9,34,35 BME is not pathognomonic for axSpA and may occur in healthy persons and in patients with non-SpA-related back pain 36,37 (Tip 8). -Enthesitis: Inflammation at the attachment of tendons and ligaments to bone is defined as increased signal in bone marrow and/or soft tissue on fluid-sensitive sequences at sites where ligaments and tendons attach to bone.…”

Novel imaging modalities in spondyloarthritis

“…As conventional radiography is considered superior to MRI in the evaluation of spinal syndesmophytes [3], follow-up of patients with axial involvement is recommended to be performed once every 2 years [4]. Thus, over their lifetime, SpA patients are repeatedly exposed to X-rays with an increased lifetime ionizing radiation exposure.…”