The last decade has seen dramatic advances in the role of MRI in the clinical management of patients with inflammatory arthritis and much research has been done investigating its diagnostic capabilities. MRI is now regarded as the most sensitive imaging modality for the detection of spondyloarthritis (SpA) in early disease which may be detected even when radiographs are completely normal. Proposed classification criteria now include a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA.
MRI can reliably measure bone marrow inflammation in the axial skeleton and is now widely used in clinical trials as a surrogate outcome to objectively measure response to anti-inflammatory therapy especially biologic agents. Recent research also confirms that the diagnostic utility of MRI is high and, as well as active inflammation, structural lesions can be clearly identified that have important diagnostic relevance. MRI research continues to provide important evidence in support of the link between active inflammation and subsequent bone formation.
In addition to improving our understanding of the findings on MRI, research has also highlighted new acquisition techniques that may have important or useful applications in imaging of the spine and bone marrow in SpA. Whole body MRI can quickly image the entire axial skeleton, shoulder, thorax, pelvis and lower extremities and may be very suitable for SpA imaging. New or newly applied techniques, such as the Dixon technique, chemical shift imaging, water excitation, high-resolution 3 dimensional acquisitions and others are being investigated, with mixed success, for potential use in detecting pathology in bone, cartilage or bone marrow.
Disclosure of Interest R. Lambert Consultant for: Abbott Laboratories
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