Ulrich Weber1, Anne Grethe Jurik2,3,4, Robert G W Lambert5,6, Walter P Maksymowych7. 1. Rheumatology, Practice Buchsbaum, Schwertstrasse 9, 8200, Schaffhausen, Switzerland. ulrich.weber02@bluewin.ch. 2. Department of Radiology, Aarhus University Hospital, Palle Juul-Jensen Boulevard 35, cross point, C 109 8200, Aarhus, Denmark. 3. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard, 99 8200, Aarhus, Denmark. 4. Institute of Regional Health Research, University of Southern Denmark, Campusvej, 55 5230, Odense M, Denmark. 5. Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada. 6. Medical Imaging Consultants, 202-11010 - 101 Street, Hys Centre, Edmonton, Alberta, T5H 4B9, Canada. 7. Department of Medicine, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta, T6G 2R3, Canada.
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. 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.
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. 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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