Meeting abstract

HIGHLIGHTS AND PITFALLS OF MRI IMAGING IN AXIAL SPONDYLOARTHRITIS PATIENTS

Martin Zlnay ; National Institute of Rheumatic Diseases, Piestany, Slovakia

Abstract

Conventional radiography is still a cornerstone of diagnosis and classification in ankylosing spondylitis (AS). However, it has limitations in early stages of the disease, because it can only visualize the consequences of inflammation. Magnetic resonance imaging (MRI) is superior to conventional radiography in early stages because of its
ability to visualize active inflammatory changes in sacroiliac joints when the pelvic radiographs are normal or equivocal. MRI of sacroiliac joints is also included in the Assessment of Axial Spondyloarthritis (ASAS) classification criteria for axial spondyloartritis (SpA). For classifi cation purposes a positive definition of MRI sacroiliitis was proposed as a clear presence of subchondral bone marrow edema (osteitis), which does not cross anatomical borders and is usually present on more consecutive slides. Besides quantitative definition of positive MRI signal (2 lesions on one slide or 1 lesion on two and more consecutive slides), the quality of MRI signal is maybe more important. There are many lesions that can mimic inflammation in the sacroiliac joints and the spine as well. The
more intense the signal is on fluid sensitive MRI sequences, the better it reflects active inflammation, because small focal bone marrow edema lesions may also occur in patients with mechanical back pain, as well as in healthy individuals. Th e presence of structural lesions such erosions and fatty metaplasia can enhance diagnostic utility of MRI in cases of not highly suggestive appearance of osteitis. When MRI findings are not clear, an additional MRI of the spine can be performed, especially of the area with the most pronounced complaints. Evidence of bone marrow edema in three or more vertebral edges is considered as highly suggestive of axial SpA, especially in patients of younger age, when degenerative changes are expected to play minor role for differential diagnosis. The author will present examples of MRI lesions typical for SpA, and especially the lesions that can mimic SpA, not sufficient for making the diagnosis of axial SpA that we are dealing with in every day practice.

Keywords

Hrčak ID:

210771

URI

https://hrcak.srce.hr/210771

Publication date:

5.12.2018.

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