Jurik Anne Grethe
Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark.
J Clin Med. 2023 Jan 29;12(3):1039. doi: 10.3390/jcm12031039.
The diagnosis of axial spondyloarthritis (axSpA) is usually based on a pattern of imaging and clinical findings due to the lack of diagnostic criteria. The increasing use of magnetic resonance imaging (MRI) of the sacroiliac joints (SIJ) to establish the diagnosis early in the pre-radiographic phase has resulted in a shift in the paradigm with an increasing frequency of axSpA diagnoses and a changed sex distribution. Non-radiographic axSpA affects males and females nearly equally, whereas ankylosing spondylitis predominantly occurs in males. The MRI-based increasing frequency of axSpA in women is mainly due to the presence of subchondral bone marrow edema (BME) on fluid-sensitive MR sequences, which may be a non-specific finding in both women and men. Due to the somewhat different pelvic tilt and SIJ anatomy, women are more prone than men to develop strain-related MRI changes and may have pregnancy-related changes. Awareness of non-specific subchondral BME at the SIJ is important as it can imply a risk for an incorrect SpA diagnosis, especially as the clinical manifestations of axSpA may also be non-specific. Knowledge of relevant MRI and clinical features of differential diagnoses is needed in the diagnostic workout of patients with suspected axSpA considering that non-SpA-related SIJ conditions are more common in patients with low back or buttock pain than axSpA sacroiliitis. The purpose of this review was to present current knowledge of the most frequent differential diagnoses to axSpA sacroiliitis by MRI taking the clinical characteristics into account.
由于缺乏诊断标准，轴性脊柱关节炎（axSpA）的诊断通常基于影像学和临床检查结果的模式。骶髂关节（SIJ）磁共振成像（MRI）在影像学前期早期用于诊断的使用增加，导致了模式的转变，axSpA诊断频率增加，性别分布也发生了变化。非放射学axSpA对男性和女性的影响几乎相同，而强直性脊柱炎主要发生在男性中。基于MRI的女性axSpA频率增加主要是由于液体敏感MR序列上存在软骨下骨髓水肿（BME），这在女性和男性中可能都是非特异性发现。由于骨盆倾斜和SIJ解剖结构略有不同，女性比男性更容易出现与劳损相关的MRI变化，并且可能有与妊娠相关的变化。认识到SIJ处非特异性软骨下BME很重要，因为它可能意味着axSpA诊断错误的风险，特别是因为axSpA的临床表现也可能是非特异性的。考虑到非SpA相关的SIJ疾病在腰背痛或臀部疼痛患者中比axSpA骶髂关节炎更常见，在疑似axSpA患者的诊断过程中需要了解相关MRI和鉴别诊断的临床特征。本综述的目的是结合临床特征，介绍目前通过MRI对axSpA骶髂关节炎最常见鉴别诊断的认识。
