Current Role of Conventional Radiography of Sacroiliac Joints in Adults and Juveniles with Suspected Axial Spondyloarthritis: Opinion from the ESSR Arthritis and Pediatric Subcommittees

Abstract

This opinion article by the European Society of Musculoskeletal Radiology Arthritis and Pediatric Subcommittees discusses the current use of conventional radiography (CR) of the sacroiliac joints in adults and juveniles with suspected axial spondyloarthritis (axSpA). The strengths and limitations of CR compared with magnetic resonance imaging (MRI) and computed tomography (CT) are presented.

Based on the current literature and expert opinions, the subcommittees recognize the superior sensitivity of MRI to detect early sacroiliitis. In adults, supplementary pelvic radiography, low-dose CT, or synthetic CT may be needed to evaluate differential diagnoses. CR remains the method of choice to detect structural changes in patients with suspected late-stage axSpA or established disease and in patients with suspected concomitant hip or pubic symphysis involvement. In children, MRI is the imaging modality of choice because it can detect active as well as structural changes and is radiation free.

Keywords

radiographs - axial spondyloarthritis - spondyloarthropathy - sacroiliitis

Publikationsverlauf

Artikel online veröffentlicht:
10. Oktober 2023

• References

• 1 Sieper J, Rudwaleit M, Baraliakos X. et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68 (Suppl. 02) ii1-ii44
• 2 Sieper J, van der Heijde D. Review: Nonradiographic axial spondyloarthritis: new definition of an old disease?. Arthritis Rheum 2013; 65 (03) 543-551
• 3 van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27 (04) 361-368
• 4 Mandl P, Navarro-Compán V, Terslev L. et al; European League Against Rheumatism (EULAR). EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015; 74 (07) 1327-1339
• 5 Zhao SS, Pittam B, Harrison NL, Ahmed AE, Goodson NJ, Hughes DM. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 60 (04) 1620-1628
• 6 Tuite MJ. Sacroiliac joint imaging. Semin Musculoskelet Radiol 2008; 12 (01) 72-82
• 7 Omar A, Sari I, Bedaiwi M, Salonen D, Haroon N, Inman RD. Analysis of dedicated sacroiliac views to improve reliability of conventional pelvic radiographs. Rheumatology (Oxford) 2017; 56 (10) 1740-1745
• 8 Khmelinskii N, Regel A, Baraliakos X. The role of imaging in diagnosing axial spondyloarthritis. Front Med (Lausanne) 2018; 5: 106
• 9 van den Berg R, Lenczner G, Feydy A. et al. Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR cohort. Arthritis Rheumatol 2014; 66 (09) 2403-2411
• 10 van Tubergen A, Heuft-Dorenbosch L, Schulpen G. et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality?. Ann Rheum Dis 2003; 62 (06) 519-525
• 11 Christiansen AA, Hendricks O, Kuettel D. et al. Limited reliability of radiographic assessment of sacroiliac joints in patients with suspected early spondyloarthritis. J Rheumatol 2017; 44 (01) 70-77
• 12 Hermann KGA, Ziegeler K, Kreutzinger V. et al. What amount of structural damage defines sacroiliitis: a CT study. RMD Open 2022; 8 (01) e001939
• 13 Diekhoff T, Eshed I, Radny F. et al. Choose wisely: imaging for diagnosis of axial spondyloarthritis. Ann Rheum Dis 2022; 81 (02) 237-242
• 14 Diekhoff T, Hermann KGA, Greese J. et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis 2017; 76 (09) 1502-1508
• 15 Bakker PAC, van den Berg R, Lenczner G. et al. Can we use structural lesions seen on MRI of the sacroiliac joints reliably for the classification of patients according to the ASAS axial spondyloarthritis criteria? Data from the DESIR cohort. Ann Rheum Dis 2017; 76 (02) 392-398
• 16 Poddubnyy D, Gaydukova I, Hermann KGA. et al. Magnetic resonance imaging compared to conventional radiographs for detection of chronic structural changes in sacroiliac joints in axial spondyloarthritis. J Rheumatol 2013; 40 (09) 1557-1565
• 17 Van Den Berghe T, Babin D, Chen M. et al. Neural network algorithm for detection of erosions and ankylosis on CT of the sacroiliac joints: multicentre development and validation of diagnostic accuracy. Eur Radiol 2023 May 23 (Epub ahead of print)
• 18 Diekhoff T, Greese J, Sieper J, Poddubnyy D, Hamm B, Hermann KA. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study. Ann Rheum Dis 2018; 77 (11) 1585-1589
• 19 Algin O, Gokalp G, Ocakoglu G. Evaluation of bone cortex and cartilage of spondyloarthropathic sacroiliac joint: efficiency of different fat-saturated MRI sequences (T1-weighted, 3D-FLASH, and 3D-DESS). Acad Radiol 2010; 17 (10) 1292-1298
• 20 Kiil RM, Mistegaard CE, Loft AG, Zejden A, Hendricks O, Jurik AG. Differences in topographical location of sacroiliac joint MRI lesions in patients with early axial spondyloarthritis and mechanical back pain. Arthritis Res Ther 2022; 24 (01) 75
• 21 Poddubnyy D, Weineck H, Diekhoff T. et al. Clinical and imaging characteristics of osteitis condensans ilii as compared with axial spondyloarthritis. Rheumatology (Oxford) 2020; 59 (12) 3798-3806
• 22 Ma L, Gao Z, Zhong Y, Meng Q. Osteitis condensans ilii may demonstrate bone marrow edema on sacroiliac joint magnetic resonance imaging. Int J Rheum Dis 2018; 21 (01) 299-307
• 23 Morbée L, Vereecke E, Laloo F, Chen M, Herregods N, Jans LBO. Common incidental findings on sacroiliac joint MRI: added value of MRI-based synthetic CT. Eur J Radiol 2023; 158: 110651
• 24 Maksymowych WP, Lambert RGW, Østergaard M. et al. MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group. Ann Rheum Dis 2019; 78 (11) 1550-1558
• 25 Maksymowych WP, Lambert RG, Baraliakos X. et al. Data-driven definitions for active and structural MRI lesions in the sacroiliac joint in spondyloarthritis and their predictive utility. Rheumatology (Oxford) 2021; 60 (10) 4778-4789
• 26 Maksymowych WP, Pedersen SJ, Weber U. et al. Central reader evaluation of MRI scans of the sacroiliac joints from the ASAS classification cohort: discrepancies with local readers and impact on the performance of the ASAS criteria. Ann Rheum Dis 2020; 79 (07) 935-942
• 27 Burgos-Vargas R. The juvenile-onset spondyloarthritides. Rheum Dis Clin North Am 2002; 28 (03) 531-560 , vi
• 28 Tse SM, Laxer RM. New advances in juvenile spondyloarthritis. Nat Rev Rheumatol 2012; 8 (05) 269-279
• 29 Burgos-Vargas R. The assessment of the spondyloarthritis international society concept and criteria for the classification of axial spondyloarthritis and peripheral spondyloarthritis: a critical appraisal for the pediatric rheumatologist. Pediatr Rheumatol Online J 2012; 10 (01) 14
• 30 Burgos-Vargas R, Rudwaleit M, Sieper J. International League of Associations for Rheumatology. The place of juvenile onset spondyloarthropathies in the Durban 1997 ILAR classification criteria of juvenile idiopathic arthritis. J Rheumatol 2002; 29 (05) 869-874
• 31 Petty RE, Southwood TR, Manners P. et al; International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31 (02) 390-392
• 32 O'Shea FD, Boyle E, Riarh R, Tse SM, Laxer RM, Inman RD. Comparison of clinical and radiographic severity of juvenile-onset versus adult-onset ankylosing spondylitis. Ann Rheum Dis 2009; 68 (09) 1407-1412
• 33 Sezen M, Baru K, Açıkel C, Kasapcopur O. The new proposal classification criteria for juvenile spondyloarthropathies. Pediatr Rheumatol Online J 2014; 12 (Suppl. 01) 45
• 34 Weiss PF, Xiao R, Biko D, Chauvin NA. Sacroiliitis at diagnosis of juvenile spondyloarthritis assessed by radiography, magnetic resonance imaging, and clinical examination. Arthritis Care Res (Hoboken) 2016; 68 (02) 187-194
• 35 Weiss PF, Xiao R, Brandon TG. et al. Radiographs in screening for sacroiliitis in children: what is the value?. Arthritis Res Ther 2018; 20 (01) 141
• 36 Jaremko JL, Liu L, Winn NJ, Ellsworth JE, Lambert RG. Diagnostic utility of magnetic resonance imaging and radiography in juvenile spondyloarthritis: evaluation of the sacroiliac joints in controls and affected subjects. J Rheumatol 2014; 41 (05) 963-970
• 37 Hemke R, Herregods N, Jaremko JL. et al. Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider. Eur Radiol 2020; 30 (10) 5237-5249
• 38 Marteau P, Adamsbaum C, Rossi-Semerano L. et al. Conventional radiography in juvenile idiopathic arthritis: Joint recommendations from the French societies for rheumatology, radiology and paediatric rheumatology. Eur Radiol 2018; 28 (09) 3963-3976
• 39 Pagnini I, Savelli S, Matucci-Cerinic M, Fonda C, Cimaz R, Simonini G. Early predictors of juvenile sacroiliitis in enthesitis-related arthritis. J Rheumatol 2010; 37 (11) 2395-2401
• 40 Herregods N, Anisau A, Schiettecatte E. et al. MRI in pediatric sacroiliitis, what radiologists should know. Pediatr Radiol 2023 March 1 (Epub ahead of print)
• 41 Sudoł-Szopińska I, Matuszewska G, Pracoń G.. Radiographic Atlas of Inflammatory Rheumatic Diseases. Otwock, Poland: Medisfera; 2022
• 42 Lambert RG, Bakker PA, van der Heijde D. et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis 2016; 75 (11) 1958-1963
• 43 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
• 44 Weiss PF, Brandon TG, Lambert RG. et al. Consensus-driven definition for unequivocal sacroiliitis on radiographs in juvenile spondyloarthritis. J Rheumatol 2023 April 15 (Epub ahead of print)