MRI is now an established imaging modality in the diagnosis and management of spondyloarthritis (SpA). It offers a number of benefits including the ability to detect pre-radiographic disease which in turn provides an opportunity for earlier diagnosis and confirmation of disease in clinically challenging cases. This opens a window for the application of potentially disease-modifying therapy at a time that may have a better impact than later treatment. MRI also allows imaging monitoring of disease and can provide crucial information about changes in active inflammation of the axial skeleton in response to treatment. On MRI, change can be seen within a few months, allowing the clinician to modify therapy as needed. When response to treatment has been poor, MRI may help to distinguish between persistent inflammation, chronic mechanical sources of pain, and complications of disease or therapy. Newer MRI sequences and techniques in development may offer further enhancements in earlier and more accurate disease detection and monitoring.

This lecture will briefly discuss the range of imaging findings that can be seen in the axial skeleton in spondyloarthritis and which features of active inflammation and structural damage are more reliably recognized and whether they are sensitive or specific for SpA. Discussion will include illustration of pit falls in interpretation and the more likely differential diagnoses for each of the MRI findings. Advanced MRI techniques that are being used in imaging the axial skeleton will be briefly reviewed. These generally fall into 2 main categories: a) attempts to improve assessment of active inflammation, and b) better detection of structural damage, in the sacroiliac joint for diagnosis, and in the spine for progression of disease.

Lambert RG, Dhillon SS, Jaremko JL. Advanced imaging of the axial skeleton in spondyloarthropathy: techniques, interpretation, and utility. Semin Musculoskelet Radiol. 2012 Nov;16(5):389-400.

Disclosure of Interest R. Lambert Consultant for: AbbVie and Synarc