Advancements in Imaging Techniques for Early Diagnosis and Management of Axial Spondyloarthritis

We aimed to introduce recent finding of imaging studies used in axial spondyloarthritis (axSpA).

Using low-dose whole spine CT (CT syndesmophyte score [CTSS]) improved diagnostic accuracy for evaluating spinal structural progression than previous method (modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS]) in axSpA. The novel definition of positive finding of sacroiliac joint (SIJ) and spine magnetic resonance imaging (MRI) enabled to diagnose axSpA earlier than plain radiography. In addition, novel MRI protocol such as volumetric interpolated breath-hold examination improved detection rate of structural change of axial joints in axSpA, Nuclear medicine imaging showed potential for diagnosis and predicting progression of axSpA. Ultrasonography guided injection is useful for controlling local joint pain of axSpA.

AxSpA is characterised by pain and inflammation of axial joints such as the SIJ and spine. Detection of active inflammatory lesions using MRI has expanded the subtypes of axSpA to include non-radiographic axSpA (nr-axSpA). In addition, many other imaging techniques have improved, and can now detect structural and early inflammatory lesions of the axial joints. In addition, a method for quantitative measurement of syndesmophytes by CTSS has been developed; this method is more accurate and sensitive than the mSASSS for detecting spinal structural damage. Here, we discuss the current knowledge and clinical advances in computed tomography, MRI, nuclear medicine imaging, and ultrasonography as imaging methods for axSpA.