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Imaging: sacroiliac joints 

Imaging: sacroiliac joints
Imaging: sacroiliac joints

Walter P. Maksymowych

and Robert G.W. Lambert

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date: 05 August 2020

Radiography of the sacroiliac (SI) joints still forms the cornerstone of diagnosis of axial spondyloarthritis (axSpA), although its limitations in early disease preclude early diagnosis. Equivocal radiographic findings of sacroiliitis should be followed by MRI evaluation of the SI joints, especially if clinical suspicion of SpA is high. Routine diagnostic evaluation for SpA by MRI of the SI joints should include simultaneous evaluation of T1-weighted (T1W) and short tau inversion recovery (STIR) or T2 fat-suppressed scans. Bone marrow oedema (BME) in subchondral bone is the primary MRI feature that points to the diagnosis of SpA, although structural lesions such as erosion and fat metaplasia may also be evident in early disease and enhance confidence in the diagnosis. Both inflammatory and structural lesions in the SI joints on MRI can now be quantified in a reliable manner to facilitate therapeutic evaluation in clinical trials and for basic and clinical research.

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