King Christian 10th Hospital for Rheumatic Diseases, Gråsten.
Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Curr Opin Rheumatol. 2018 Jul;30(4):324-333. doi: 10.1097/BOR.0000000000000512.
To summarize recent advances and challenges of using MRI toward early recognition of axial spondyloarthritis (SpA).
Low-grade bone marrow edema (BME) on sacroiliac joint (SIJ) MRI is nonspecific and may be misleading in recognition of axial SpA. Structural features on SIJ MRI along with BME may not only facilitate recognition of early disease, but also enhance specificity. Structural lesions on MRI and low-dose computed tomography are highly concordant, adding to criterion validity of SIJ MRI. There is accumulating evidence that SIJ MRI due to superior reliability of structural lesions may supplant the traditional imaging approach by pelvic radiographs in healthcare settings in which MRI is readily available. Pilot initiatives exploring the bone remodeling cascade in SIJs showed early reparative response upon biological treatment. Methodological challenges regarding evaluation and data processing of imaging examinations need to be addressed to enhance reproducibility and specificity of imaging in SpA.
Evaluation of SIJ MRI is contextual incorporating structural lesions and BME. MRI is but one element in pattern recognition toward diagnosis. An unmet need is dissemination of advances in imaging in SpA to the broad community of rheumatologists and radiologists.
总结使用 MRI 进行早期诊断中轴型脊柱关节炎（SpA）的最新进展和挑战。
骶髂关节（SIJ）MRI 上的低级别骨髓水肿（BME）不具特异性，可能会对中轴型 SpA 的识别产生误导。SIJ MRI 上的结构特征和 BME 不仅有助于早期疾病的识别，而且还能提高特异性。MRI 和低剂量 CT 上的结构损伤高度一致，增加了 SIJ MRI 的标准效度。越来越多的证据表明，由于 SIJ MRI 具有结构损伤的可靠性更高，因此在 MRI 易于获取的医疗环境中，可能会替代传统的骨盆 X 线摄影的影像学方法。探索 SIJ 骨重塑级联的初步研究显示，生物治疗后早期出现修复反应。需要解决影像学检查评估和数据处理方面的方法学挑战，以提高 SpA 影像学的可重复性和特异性。
SIJ MRI 的评估结合了结构损伤和 BME。MRI 只是在针对诊断的模式识别中的一个因素。目前仍需要向广大风湿病学家和放射科医生推广 SpA 影像学的进展。
