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Semin Musculoskelet Radiol 2025; 29(02): 302-314
DOI: 10.1055/s-0045-1802662
Review Article

Whole-body Magnetic Resonance Imaging in Inflammatory Spine and Joint Disease

Mariana Batista Rosa Pinto 
1   Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
2   Department of Radiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
,
Isabela Azevedo Nicodemos da Cruz 
1   Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
2   Department of Radiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
,
Paulo de Tarso Kawakami Perez 
1   Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
2   Department of Radiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
,
Marcelo Astolfi Caetano Nico 
1   Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
,
Alípio Gomes Ormond Filho 
1   Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
,
Julio Brandão Guimarães 
1   Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
2   Department of Radiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
3   Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
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Abstract

Whole-body magnetic resonance imaging (WB-MRI) can effectively diagnose rheumatologic diseases with systemic and multifocal characteristics, such as spondyloarthritis, chronic recurrent multifocal osteomyelitis, and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, among others. Advances in rheumatic disease treatments have emphasized the importance of early diagnosis for effective management, function preservation, and improved quality of life. WB-MRI offers comprehensive imaging of the musculoskeletal system, detecting early and subtle disease changes that traditional methods might overlook. Initially used for spondyloarthritis, the technique has recently expanded to other rheumatic diseases and is becoming the gold standard for diagnosing and monitoring chronic nonbacterial osteomyelitis in pediatric patients. This review article presents the current status of WB-MRI in rheumatologic conditions.

Keywords

musculoskeletal imaging - whole-body magnetic resonance imaging - rheumatologic disease - spondyloarthritis - chronic nonbacterial osteomyelitis


Publication History

Article published online:
31 March 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Chang EY, Chen KC, Huang BK, Kavanaugh A. Adult inflammatory arthritides: what the radiologist should know. Radiographics 2016; 36 (06) 1849-1870
    CrossrefPubMedSearch in Google Scholar
  • 2 Lecouvet FE, Michoux N, Nzeusseu Toukap A. et al. The increasing spectrum of indications of whole-body MRI beyond oncology: imaging answers to clinical needs. Semin Musculoskelet Radiol 2015; 19 (04) 348-362
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Weckbach S. Whole-body MRI for inflammatory arthritis and other multifocal rheumatoid diseases. Semin Musculoskelet Radiol 2012; 16 (05) 377-388
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Barakat E, Kirchgesner T, Triqueneaux P, Galant C, Stoenoiu M, Lecouvet FE. Whole-body magnetic resonance imaging in rheumatic and systemic diseases: from emerging to validated indications. Magn Reson Imaging Clin N Am 2018; 26 (04) 581-597
    CrossrefPubMedSearch in Google Scholar
  • 5 Darge K, Jaramillo D, Siegel MJ. Whole-body MRI in children: current status and future applications. Eur J Radiol 2008; 68 (02) 289-298
    CrossrefPubMedSearch in Google Scholar
  • 6 Damasio MB, Magnaguagno F, Stagnaro G. Whole-body MRI: non-oncological applications in paediatrics. Radiol Med 2016; 121 (05) 454-461
    CrossrefPubMedSearch in Google Scholar
  • 7 Zadig P, von Brandis E, Lein RK, Rosendahl K, Avenarius D, Ording Müller LS. Whole-body magnetic resonance imaging in children—how and why? A systematic review. Pediatr Radiol 2021; 51 (01) 14-24
    CrossrefPubMedSearch in Google Scholar
  • 8 Østergaard M, Eshed I, Althoff CE. et al. Whole-body magnetic resonance imaging in inflammatory arthritis: systematic literature review and first steps toward standardization and an OMERACT scoring system. J Rheumatol 2017; 44 (11) 1699-1705
    CrossrefPubMedSearch in Google Scholar
  • 9 Schick F. Whole-body MRI at high field: technical limits and clinical potential. Eur Radiol 2005; 15 (05) 946-959
    CrossrefPubMedSearch in Google Scholar
  • 10 Cruz IAN, Fayad LM, Ahlawat S. et al. Whole-body MRI in musculoskeletal oncology: a comprehensive review with recommendations. Radiol Imaging Cancer 2023; 5 (03) e220107
    CrossrefPubMedSearch in Google Scholar
  • 11 Nico MAC, Araújo FF, Guimarães JB. et al. Chronic nonbacterial osteomyelitis: the role of whole-body MRI. Insights Imaging 2022; 13 (01) 149
    CrossrefPubMedSearch in Google Scholar
  • 12 Lins CF, Salmon CEG, Nogueira-Barbosa MH. Applications of the Dixon technique in the evaluation of the musculoskeletal system. Radiol Bras 2021; 54 (01) 33-42
    CrossrefPubMedSearch in Google Scholar
  • 13 Guerini H, Omoumi P, Guichoux F. et al. Fat suppression with Dixon techniques in musculoskeletal magnetic resonance imaging: a pictorial review. Semin Musculoskelet Radiol 2015; 19 (04) 335-347
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Aydıngöz Ü, Yıldız AE, Ergen FB. Zero echo time musculoskeletal MRI: technique, optimization, applications, and pitfalls. Radiographics 2022; 42 (05) 1398-1414
    CrossrefPubMedSearch in Google Scholar
  • 15 Lin C, Liu D, Wen H, Liu B, Tu L, Gu J. Zero echo time MRI improved detection of erosions and sclerosis in the sacroiliac joint in comparison with LAVA-flex. Front Endocrinol (Lausanne) 2023; 14: 1167334
    CrossrefPubMedSearch in Google Scholar
  • 16 Freeston J, Marzetti M, Larkman N, Rowbotham E, Emery P, Grainger A. Whole-body MRI for the investigation of joint involvement in inflammatory arthritis. Skeletal Radiol 2024; 53 (05) 935-945
    CrossrefPubMedSearch in Google Scholar
  • 17 Khanna G, Sato TSP, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 2009; 29 (04) 1159-1177
    CrossrefPubMedSearch in Google Scholar
  • 18 Jansson AF, Grote V. ESPED Study Group. Nonbacterial osteitis in children: data of a German Incidence Surveillance Study. Acta Paediatr 2011; 100 (08) 1150-1157
    CrossrefPubMedSearch in Google Scholar
  • 19 Hofmann SR, Schnabel A, Rösen-Wolff A, Morbach H, Girschick HJ, Hedrich CM. Chronic nonbacterial osteomyelitis: pathophysiological concepts and current treatment strategies. J Rheumatol 2016; 43 (11) 1956-1964
    CrossrefPubMedSearch in Google Scholar
  • 20 Hedrich CM, Hofmann SR, Pablik J, Morbach H, Girschick HJ. Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO). Pediatr Rheumatol Online J 2013; 11 (01) 47
    CrossrefPubMedSearch in Google Scholar
  • 21 Hofmann SR, Kapplusch F, Girschick HJ. et al. Chronic recurrent multifocal osteomyelitis (CRMO): presentation, pathogenesis, and treatment. Curr Osteoporos Rep 2017; 15 (06) 542-554
    CrossrefPubMedSearch in Google Scholar
  • 22 Zhao Y, Ferguson PJ. Chronic nonbacterial osteomyelitis and chronic recurrent multifocal osteomyelitis in children. Pediatr Clin North Am 2018; 65 (04) 783-800
    CrossrefPubMedSearch in Google Scholar
  • 23 Iyer RS, Thapa MM, Chew FS. Chronic recurrent multifocal osteomyelitis: review. AJR Am J Roentgenol 2011; 196 (6, Suppl): S87-S91
    CrossrefPubMedSearch in Google Scholar
  • 24 Aydıngöz Ü, Yıldız AE, Ayaz E, Batu ED, Özen S. Preferential involvement of the pelvis and hips along with active sacroiliitis in chronic nonbacterial osteomyelitis: MRI of 97 patients from a single tertiary referral center. Eur Radiol 2024; 34 (08) 4979-4987
    CrossrefPubMedSearch in Google Scholar
  • 25 Roderick MR, Shah R, Rogers V, Finn A, Ramanan AV. Chronic recurrent multifocal osteomyelitis (CRMO)—advancing the diagnosis. Pediatr Rheumatol Online J 2016; 14 (01) 47
    CrossrefPubMedSearch in Google Scholar
  • 26 Andronikou S, Kraft JK, Offiah AC. et al. Whole-body MRI in the diagnosis of paediatric CNO/CRMO. Rheumatology (Oxford) 2020; 59 (10) 2671-2680
    CrossrefPubMedSearch in Google Scholar
  • 27 Voit AM, Arnoldi AP, Douis H. et al. Whole-body magnetic resonance imaging in chronic recurrent multifocal osteomyelitis: clinical longterm assessment may underestimate activity. J Rheumatol 2015; 42 (08) 1455-1462
    CrossrefPubMedSearch in Google Scholar
  • 28 Beck C, Morbach H, Beer M. et al. Chronic nonbacterial osteomyelitis in childhood: prospective follow-up during the first year of anti-inflammatory treatment. Arthritis Res Ther 2010; 12 (02) R74
    CrossrefPubMedSearch in Google Scholar
  • 29 Zhao Y, Chauvin NA, Jaramillo D, Burnham JM. Aggressive therapy reduces disease activity without skeletal damage progression in chronic nonbacterial osteomyelitis. J Rheumatol 2015; 42 (07) 1245-1251
    CrossrefPubMedSearch in Google Scholar
  • 30 Roderick M, Shah R, Finn A, Ramanan AV. Efficacy of pamidronate therapy in children with chronic non-bacterial osteitis: disease activity assessment by whole body magnetic resonance imaging. Rheumatology (Oxford) 2014; 53 (11) 1973-1976
    CrossrefPubMedSearch in Google Scholar
  • 31 Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007; 369 (9563): 767-778
    CrossrefPubMedSearch in Google Scholar
  • 32 Sheybani EF, Khanna G, White AJ, Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics 2013; 33 (05) 1253-1273
    CrossrefPubMedSearch in Google Scholar
  • 33 Panwar J, Tolend M, Redd B. et al. Consensus-driven conceptual development of a standardized whole body-MRI scoring system for assessment of disease activity in juvenile idiopathic arthritis: MRI in JIA OMERACT working group. Semin Arthritis Rheum 2021; 51 (06) 1350-1359
    CrossrefPubMedSearch in Google Scholar
  • 34 Deplano L, Piga M, Porcu M. et al. Whole-body MRI in rheumatology: major advances and future perspectives. Diagnostics (Basel) 2021; 11 (10) 1770
    CrossrefPubMedSearch in Google Scholar
  • 35 Aquino MR, Tse SML, Gupta S, Rachlis AC, Stimec J. Whole-body MRI of juvenile spondyloarthritis: protocols and pictorial review of characteristic patterns. Pediatr Radiol 2015; 45 (05) 754-762
    CrossrefPubMedSearch in Google Scholar
  • 36 Consolaro A, Ruperto N, Bazso A. et al. Final validation of a new composite disease activity score for juvenile idiopathic arthritis: the Juvenile Arthritis Disease Activity Score (JADAS). Pediatr Rheumatol 2008; 6 (01) 115
    CrossrefPubMedSearch in Google Scholar
  • 37 Earwaker JWS, Cotten A. SAPHO: syndrome or concept? Imaging findings. Skeletal Radiol 2003; 32 (06) 311-327
    CrossrefPubMedSearch in Google Scholar
  • 38 Khanna L, El-Khoury GY. SAPHO syndrome—a pictorial assay. Iowa Orthop J 2012; 32: 189-195
    PubMedSearch in Google Scholar
  • 39 Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet 2017; 390 (10089): 73-84
    CrossrefPubMedSearch in Google Scholar
  • 40 Weber U, Pfirrmann CW, Kissling RO, Hodler J, Zanetti M. Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis. BMC Musculoskelet Disord 2007; 8 (01) 20
    CrossrefPubMedSearch in Google Scholar
  • 41 Dagfinrud H, Mengshoel AM, Hagen KB, Loge JH, Kvien TK. Health status of patients with ankylosing spondylitis: a comparison with the general population. Ann Rheum Dis 2004; 63 (12) 1605-1610
    CrossrefPubMedSearch in Google Scholar
  • 42 Althoff CE, Sieper J, Song IH. et al. Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI. Ann Rheum Dis 2013; 72 (06) 967-973
    CrossrefPubMedSearch in Google Scholar
  • 43 Hermann KGA, Braun J, Fischer T, Reisshauer H, Bollow M. Magnetresonanztomographie der Sakroiliitis: Anatomie, Pathohistologie, MR-Morphologie und Graduierung. Radiologe 2004; 44 (03) 217-228
    CrossrefPubMedSearch in Google Scholar
  • 44 Mager AK, Althoff CE, Sieper J, Hamm B, Hermann KGA. Role of whole-body magnetic resonance imaging in diagnosing early spondyloarthritis. Eur J Radiol 2009; 71 (02) 182-188
    CrossrefPubMedSearch in Google Scholar
  • 45 Rudwaleit M, van der Heijde D, Landewé R. et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68 (06) 777-783
    CrossrefPubMedSearch in Google Scholar
  • 46 Diekhoff T, Lambert R, Hermann KG. MRI in axial spondyloarthritis: understanding an ‘ASAS-positive MRI’ and the ASAS classification criteria. Skeletal Radiol 2022; 51 (09) 1721-1730
    CrossrefPubMedSearch in Google Scholar
  • 47 Ginsburg WW, Cohen MD. Peripheral arthritis in ankylosing spondylitis. A review of 209 patients followed up for more than 20 years. Mayo Clin Proc 1983; 58 (09) 593-596
    PubMedSearch in Google Scholar
  • 48 Lambert RGW, Dhillon SS, Jhangri GS. et al. High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease. Arthritis Rheum 2004; 51 (05) 681-690
    CrossrefPubMedSearch in Google Scholar
  • 49 Kerschbaumer A, Fenzl KH, Erlacher L, Aletaha D. An overview of psoriatic arthritis - epidemiology, clinical features, pathophysiology and novel treatment targets. Wien Klin Wochenschr 2016; 128 (21–22): 791-795
    CrossrefPubMedSearch in Google Scholar
  • 50 Coates LC, Hodgson R, Conaghan PG, Freeston JE. MRI and ultrasonography for diagnosis and monitoring of psoriatic arthritis. Best Pract Res Clin Rheumatol 2012; 26 (06) 805-822
    CrossrefPubMedSearch in Google Scholar
  • 51 McGonagle D. Imaging the joint and enthesis: insights into pathogenesis of psoriatic arthritis. Ann Rheum Dis 2005; 64 (Suppl. 02) ii58-ii60
    CrossrefPubMedSearch in Google Scholar
  • 52 Jacobson JA, Girish G, Jiang Y, Resnick D. Radiographic evaluation of arthritis: inflammatory conditions. Radiology 2008; 248 (02) 378-389
    CrossrefPubMedSearch in Google Scholar
  • 53 Weckbach S, Schewe S, Michaely HJ, Steffinger D, Reiser MF, Glaser C. Whole-body MR imaging in psoriatic arthritis: additional value for therapeutic decision making. Eur J Radiol 2011; 77 (01) 149-155
    CrossrefPubMedSearch in Google Scholar
  • 54 Rutka K, Garkowski A, Karaszewska K, Łebkowska U. Imaging in diagnosis of systemic sclerosis. J Clin Med 2021; 10 (02) 248
    CrossrefPubMedSearch in Google Scholar
  • 55 Avouac J, Walker UA, Hachulla E. et al; EUSTAR collaborators*, EUSTAR collaborators. Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study. Ann Rheum Dis 2016; 75 (01) 103-109
    CrossrefPubMedSearch in Google Scholar
  • 56 Leão RV, Calich ALG, Calich I. et al. Magnetic resonance imaging findings in patients with polymyalgia rheumatica. Radiol Bras 2022; 55 (06) 346-352
    PubMedSearch in Google Scholar
  • 57 Racanelli V, Prete M, Minoia C, Favoino E, Perosa F. Rheumatic disorders as paraneoplastic syndromes. Autoimmun Rev 2008; 7 (05) 352-358
    CrossrefPubMedSearch in Google Scholar
  • 58 Rigante D, Esposito S. A roadmap for fever of unknown origin in children. Int J Immunopathol Pharmacol 2013; 26 (02) 315-326
    CrossrefPubMedSearch in Google Scholar
  • 59 Dayal R, Agarwal D. Fever in children and fever of unknown origin. Indian J Pediatr 2016; 83 (01) 38-43
    CrossrefPubMedSearch in Google Scholar
  • 60 Sommer OJ, Kladosek A, Weiler V, Czembirek H, Boeck M, Stiskal M. Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics 2005; 25 (02) 381-398
    CrossrefPubMedSearch in Google Scholar
  • 61 Smolen JS, Landewé R, Breedveld FC. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014; 73 (03) 492-509
    CrossrefPubMedSearch in Google Scholar
  • 62 Axelsen MB, Eshed I, Duer-Jensen A, Møller JM, Pedersen SJ, Østergaard M. Whole-body MRI assessment of disease activity and structural damage in rheumatoid arthritis: first step towards an MRI joint count. Rheumatology (Oxford) 2014; 53 (05) 845-853
    CrossrefPubMedSearch in Google Scholar
  • 63 Kono M, Kamishima T, Yasuda S. et al. Effectiveness of whole-body magnetic resonance imaging for the efficacy of biologic anti-rheumatic drugs in patients with rheumatoid arthritis: a retrospective pilot study. Mod Rheumatol 2017; 27 (06) 953-960
    CrossrefPubMedSearch in Google Scholar