Additionally, MRI findings should be interpreted with specific attention to identify associated morphologic findings such as disc degeneration or osteophytes that favor degenerative changes rather than axSpA, because both inflammatory and fatty lesions can occur in degenerative changes [124]. Contrast-enhanced MRI can demonstrate active inflammatory changes of the spine in axSpA, although multiple studies show that noncontrast and contrast-enhanced MRI have overall similar diagnostic utility for axSpA [9,125- 129]. Contrast-enhanced MRI has been reported to increase reliability of MRI interpretation in 1 study [9]. Radiography Spine Area of Interest If radiographs and MRI of the sacroiliac joints have been negative, radiographic evaluation of the spine can be obtained to evaluate for the structural imaging findings of axSpA, including syndesmophytes, erosions, shiny corners, vertebral body squaring, and ankylosis [38]. Although radiographs show structural changes, they will not demonstrate the inflammatory changes or fatty infiltration that can be demonstrated on MRI. Inflammatory Back Pain US Spine Area of Interest US is not beneficial as a diagnostic tool for the evaluation of sacroiliitis in patients with suspected axSpA because of its lack of established diagnostic utility [22]. Importantly, US provides limited evaluation of the superficial posterior margins of the spine, and therefore many structural details are not demonstrated. There is a paucity of evidence literature evaluating US in the spine in patients with axSpA. One study demonstrates that resistive indices of the thoracolumbar paraspinal areas are also decreased in patients with AS, similar to findings reported at the sacroiliac joints [132]. Variant 4: Known axial spondyloarthritis. Follow-up for treatment response or disease progression. The body regions covered in this clinical scenario are the sacroiliac joints, cervical, thoracic, and lumbar spine.
Inflammatory Back Pain Known or Suspected Axial Spondyloarthropathy PCAs. Additionally, MRI findings should be interpreted with specific attention to identify associated morphologic findings such as disc degeneration or osteophytes that favor degenerative changes rather than axSpA, because both inflammatory and fatty lesions can occur in degenerative changes [124]. Contrast-enhanced MRI can demonstrate active inflammatory changes of the spine in axSpA, although multiple studies show that noncontrast and contrast-enhanced MRI have overall similar diagnostic utility for axSpA [9,125- 129]. Contrast-enhanced MRI has been reported to increase reliability of MRI interpretation in 1 study [9]. Radiography Spine Area of Interest If radiographs and MRI of the sacroiliac joints have been negative, radiographic evaluation of the spine can be obtained to evaluate for the structural imaging findings of axSpA, including syndesmophytes, erosions, shiny corners, vertebral body squaring, and ankylosis [38]. Although radiographs show structural changes, they will not demonstrate the inflammatory changes or fatty infiltration that can be demonstrated on MRI. Inflammatory Back Pain US Spine Area of Interest US is not beneficial as a diagnostic tool for the evaluation of sacroiliitis in patients with suspected axSpA because of its lack of established diagnostic utility [22]. Importantly, US provides limited evaluation of the superficial posterior margins of the spine, and therefore many structural details are not demonstrated. There is a paucity of evidence literature evaluating US in the spine in patients with axSpA. One study demonstrates that resistive indices of the thoracolumbar paraspinal areas are also decreased in patients with AS, similar to findings reported at the sacroiliac joints [132]. Variant 4: Known axial spondyloarthritis. Follow-up for treatment response or disease progression. The body regions covered in this clinical scenario are the sacroiliac joints, cervical, thoracic, and lumbar spine.