CHAPTER 11: Magnetic resonance imaging in axial spondyloarthritis 2: evidence for application
Abstract
Magnetic resonance imaging (MRI) plays a key role in the diagnosis of patients with axSpA. When the diagnosis of axSpA cannot be established based on clinical features and conventional radiography, and axSpA is still suspected, MRI of the sacroiliac (SI) joints is recommended. The presence of bone edema, fatty infiltration or erosion in the SI joints suggests the diagnosis of axSpA. The presence of more than one of these features increases diagnostic confidence. The MRI findings with the greatest diagnostic value in patients with suspected axSpA are structural changes in the SI joints alone or in combination with bone edema. In the study conducted by Baraliakos et al., it was observed that both erosions and fatty lesions showed a greater specificity for the diagnosis and that the combination of bone edema with erosions had a higher positive predictive value (86.5%). According to the latest update of SI lesions that can predict diagnosis carried out by the ASAS MRI expert group, it was concluded that bone edema in 4 quadrants or 3 consecutive slices, erosions in 3 quadrants or 2 consecutive slices in the same place and fatty lesions in 5 quadrants or 3 consecutive slices or extensive fatty lesions (> 1 cm), present a high positive predictive value for the diagnosis.References
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