Musculoskeletal Radiology, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Semin Musculoskelet Radiol. 2023 Feb;27(1):91-102. doi: 10.1055/s-0043-1761496. Epub 2023 Mar 3.
Magnetic resonance imaging (MRI) of the axial skeleton, spine, and sacroiliac (SI) joints is critical for the early detection and follow-up of inflammatory rheumatologic disorders such as axial spondyloarthritis, rheumatoid arthritis, and SAPHO/CRMO (synovitis, acne, pustulosis, hyperostosis, and osteitis/chronic recurrent multifocal osteomyelitis). To offer a valuable report to the referring physician, disease-specific knowledge is essential. Certain MRI parameters can help the radiologist provide an early diagnosis and lead to effective treatment. Awareness of these hallmarks may help avoid misdiagnosis and unnecessary biopsies. A bone marrow edema-like signal plays an important role in reports but is not disease specific. Age, sex, and history should be considered in interpreting MRI to prevent overdiagnosis of rheumatologic disease. Differential diagnoses-degenerative disk disease, infection, and crystal arthropathy-are addressed here. Whole-body MRI may be helpful in diagnosing SAPHO/CRMO.
轴性脊柱关节炎、类风湿关节炎和 SAPHO/CRMO（滑膜炎、痤疮、脓疱病、骨肥厚和骨炎/慢性复发性多灶性骨髓炎）等炎症性风湿性疾病的早期检测和随访，对轴向骨骼、脊柱和骶髂（SI）关节的磁共振成像（MRI）至关重要。为了向转诊医生提供有价值的报告，疾病特异性知识是必不可少的。某些 MRI 参数可以帮助放射科医生做出早期诊断，并导致有效的治疗。了解这些特征可能有助于避免误诊和不必要的活检。骨髓水肿样信号在报告中起着重要作用，但不具有疾病特异性。在解释 MRI 时，应考虑年龄、性别和病史，以防止风湿性疾病的过度诊断。本文讨论了鉴别诊断——退行性椎间盘疾病、感染和晶体性关节病。全身 MRI 可能有助于诊断 SAPHO/CRMO。
