title: Imaging in Spondyloarthritis: Controversies in Recognition of Early Disease.
abstract: Advanced imaging has become essential for recognition of clinically suspected early spondyloarthritis. This report summarizes recent progress towards a data-driven comprehensive definition of a positive sacroiliac joint MRI in axial spondyloarthritis, which incorporates contextual information provided by structural lesions alongside with active changes. A focus is on emerging limitations and challenges with increasing use of imaging in spondyloarthritis. We discuss the ongoing controversy as to whether sacroiliac joint MRI due to its superior reliability and ability to depict both structural and active lesions should be the preferred imaging modality in early disease over the traditional approach with pelvic radiographs. Another challenge is transferring the expanding knowledge about imaging evaluation in spondyloarthritis to the community of rheumatologists and radiologists. Advanced imaging modalities will not become the gold standard for diagnosis of spondyloarthritis, which remains a process of composite deduction based on complementary information obtained from clinical, laboratory, and imaging assessment.
authors.affiliation: King Christian 10th Hospital for Rheumatic Diseases, Toldbodgade 3, DK-6300, Gråsten, Denmark. ulrich.weber02@bluewin.ch.|Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. ulrich.weber02@bluewin.ch.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Weber
authors.affiliation: Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.|Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus, Denmark.|Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart, Oestre Hougvej 55, 5500, Middelfart, Denmark.
authors.forename: Anne Grethe
authors.initials: AG
authors.lastname: Jurik
authors.affiliation: Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Robert G W
authors.initials: RG
authors.lastname: Lambert
authors.affiliation: Department of Medicine, University of Alberta, 116 St. and 85 Ave, Edmonton, AB, T6G 2R3, Canada.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
mesh_terms: D042241:Early Diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging; D025241:Spondylarthritis / Q000000981:diagnostic imaging*
keywords: Ankylosing spondylitis; Diagnosis; Imaging; Magnetic resonance imaging; Spondyloarthritis; Structural lesions