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MRI of enthesitis of the appendicular skeleton in spondyloarthritis
  1. Iris Eshed1,*,
  2. Matthias Bollow2,*,
  3. Dennis G McGonagle3,
  4. Ai Lyn Tan3,
  5. Christian E Althoff4,
  6. Patrick Asbach4,
  7. Kay-Geert A Hermann4
  1. 1
    Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
  2. 2
    Department of Radiology, Augusta Hospital, Bochum, Germany
  3. 3
    Academic Unit of Musculoskeletal Diseases, The University of Leeds, Leeds, UK
  4. 4
    Department of Radiology, Charité Medical School, Berlin, Germany
  1. Dr K-G A Hermann, Department of Radiology, Charité Medical School, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; kgh{at}


Entheses are sites where tendons, ligaments, joint capsules or fascia attach to bone. Inflammation of the entheses (enthesitis) is a well-known hallmark of spondyloarthritis (SpA). As entheses are associated with adjacent, functionally related structures, the concepts of an enthesis organ and functional entheses have been proposed. This is important in interpreting imaging findings in entheseal-related diseases. Conventional radiographs and CT are able to depict the chronic changes associated with enthesitis but are of very limited use in early disease. In contrast, MRI is sensitive for detecting early signs of enthesitis and can evaluate both soft-tissue changes and intraosseous abnormalities of active enthesitis. It is therefore useful for the early diagnosis of enthesitis-related arthropathies and monitoring therapy. Current knowledge and typical MRI features of the most commonly involved entheses of the appendicular skeleton in patients with SpA are reviewed. The MRI appearances of inflammatory and degenerative enthesopathy are described. New options for imaging enthesitis, including whole-body MRI and high-resolution microscopy MRI, are briefly discussed.

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  • These two authors contributed equally to this article.

  • Competing interests: None.

  • Abbreviations:
    ankylosing spondylitis
    psoriatic arthritis
    short tau inversion recovery

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