Multiple studies have examined diffusion-weighted imaging and dynamic contrast-enhanced MRI to determine their diagnostic utility and performance as imaging biomarkers of inflammation. Although these studies show correlation between diffusion-weighted imaging, dynamic contrast-enhanced, and conventional sequences, there is no evidence that these MRI techniques provide additional diagnostic utility compared with conventional MRI sequences [95- 106]. Contrast-enhanced MRI can demonstrate active inflammatory changes of the sacroiliac joints in axSpA, although multiple studies show that noncontrast and contrast-enhanced MRI have overall similar diagnostic utility for axSpA [107-111]. Contrast-enhanced MRI has been reported to increase the diagnostic confidence of MRI interpretation in 1 study [107]. MRI Sacroiliac Joints and Spine Area of Interest After radiography is performed, MRI is the next imaging technique of choice in the evaluation of suspected axSpA [1,3,19,22]. MRI of the sacroiliac joints and spine is associated with improved diagnostic confidence in axSpA and yields findings that stimulate changes in both diagnosis and treatment plans for patients [74]. Although there is agreement in the literature and among experts that MRI should include the sacroiliac joints, there is not a consistently established convention to guide the clinician on whether to image only the sacroiliac joints or both the sacroiliac joints and the spine in patients with suspected axSpA [1,3,19,22]. Not unexpectedly, there is heterogeneity in clinical practice regarding the use of MRI to evaluate the sacroiliac joints and/or spine in these patients [112]. One study has shown that the majority of patients can be diagnosed with axSpA by obtaining MRI of the sacroiliac joints only [60]. Another study shows that the addition of spine MRI to sacroiliac joint MRI adds little incremental value in the diagnosis of nonradiographic axSpA [113].
Inflammatory Back Pain Known or Suspected Axial Spondyloarthropathy PCAs. Multiple studies have examined diffusion-weighted imaging and dynamic contrast-enhanced MRI to determine their diagnostic utility and performance as imaging biomarkers of inflammation. Although these studies show correlation between diffusion-weighted imaging, dynamic contrast-enhanced, and conventional sequences, there is no evidence that these MRI techniques provide additional diagnostic utility compared with conventional MRI sequences [95- 106]. Contrast-enhanced MRI can demonstrate active inflammatory changes of the sacroiliac joints in axSpA, although multiple studies show that noncontrast and contrast-enhanced MRI have overall similar diagnostic utility for axSpA [107-111]. Contrast-enhanced MRI has been reported to increase the diagnostic confidence of MRI interpretation in 1 study [107]. MRI Sacroiliac Joints and Spine Area of Interest After radiography is performed, MRI is the next imaging technique of choice in the evaluation of suspected axSpA [1,3,19,22]. MRI of the sacroiliac joints and spine is associated with improved diagnostic confidence in axSpA and yields findings that stimulate changes in both diagnosis and treatment plans for patients [74]. Although there is agreement in the literature and among experts that MRI should include the sacroiliac joints, there is not a consistently established convention to guide the clinician on whether to image only the sacroiliac joints or both the sacroiliac joints and the spine in patients with suspected axSpA [1,3,19,22]. Not unexpectedly, there is heterogeneity in clinical practice regarding the use of MRI to evaluate the sacroiliac joints and/or spine in these patients [112]. One study has shown that the majority of patients can be diagnosed with axSpA by obtaining MRI of the sacroiliac joints only [60]. Another study shows that the addition of spine MRI to sacroiliac joint MRI adds little incremental value in the diagnosis of nonradiographic axSpA [113].