Eshed Iris, Hermann Kay Geert A
Sheba Medical Center, Department of Radiology, Tel Hashomer, affiliated to the Tel Aviv University School of Medicine, Tel Aviv, Israel.
Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
Skeletal Radiol. 2025 May 10. doi: 10.1007/s00256-025-04935-0.
Axial spondyloarthritis (axSpA) is a chronic inflammatory condition predominantly affecting the sacroiliac joints and spine. Early and accurate diagnosis is crucial to prevent structural damage and improve patient outcomes. Imaging plays a pivotal role in axSpA diagnosis, monitoring, and clinical trials, offering insights into both inflammatory activity and structural progression. Conventional radiography has been foundational for detecting structural changes, such as syndesmophytes and erosions, but it is limited by poor sensitivity for early disease detection and significant interobserver variability. Advanced imaging modalities, such as magnetic resonance imaging (MRI) and low-dose computed tomography (ld-CT), have emerged as more sensitive tools. MRI excels in identifying active inflammation, particularly bone marrow edema, and is integral to early diagnosis and disease monitoring. ld-CT provides superior spatial resolution for detecting structural lesions while minimizing radiation exposure. However, challenges remain in achieving standardized imaging protocols and consistent scoring systems across clinical trials. Scoring systems like the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Spondyloarthritis Research Consortium of Canada (SPARCC) scores, and Berlin methods require rigorous calibration to ensure reliability. The purpose of this review is to explore the strengths and limitations as well as the use in clinical trials of the different imaging modalities and to offer guidance on selecting the most suitable imaging techniques for assessing both disease activity and structural progression in clinical trials.
轴性脊柱关节炎（axSpA）是一种主要影响骶髂关节和脊柱的慢性炎症性疾病。早期准确诊断对于预防结构损伤和改善患者预后至关重要。影像学在axSpA的诊断、监测及临床试验中发挥着关键作用，能深入了解炎症活动和结构进展情况。传统X线摄影一直是检测结构改变（如骨桥和侵蚀）的基础，但它在早期疾病检测方面敏感性较差，且观察者间差异较大。先进的成像方式，如磁共振成像（MRI）和低剂量计算机断层扫描（ld-CT），已成为更敏感的工具。MRI在识别活动性炎症（尤其是骨髓水肿）方面表现出色，是早期诊断和疾病监测不可或缺的手段。ld-CT在检测结构病变时具有更高的空间分辨率，同时能将辐射暴露降至最低。然而，在临床试验中实现标准化成像方案和一致的评分系统仍面临挑战。像改良斯托克强直性脊柱炎脊柱评分（mSASSS）、加拿大脊柱关节炎研究联盟（SPARCC）评分和柏林方法等评分系统需要严格校准以确保可靠性。本综述的目的是探讨不同成像方式的优势和局限性及其在临床试验中的应用，并为在临床试验中选择最适合评估疾病活动和结构进展的成像技术提供指导。
