Recommendations for MRI Assessment in Managing Axial Spondyloarthritis

person in MRI machine
person in MRI machine
Investigators created checklists and templates based on the opinions of rheumatologists and radiologists in an effort to standardize MRI assessment of the spine and sacroiliac joints in patients with axial spondyloarthritis and/or inflammatory spinal pain.

According to emerging new evidence and expert consensus, a scientific committee of rheumatologists and radiologists developed standardized checklists and templates for magnetic resonance imaging (MRI) of the spine and sacroiliac joints in patients with axial spondyloarthritis (axSpA) or inflammatory spinal pain. This report was published in Rheumatology International.

Investigators performed a literature review focused on the use of MRI in axSpA diagnosis to monitor disease activity and structural changes and to predict treatment effect and disease outcomes. Checklist items and proposed templates were rated on a 9-point Likert scale; the scientific committee then elicited opinions from a panel of 17 experts, and together they agreed on definitive checklists, report templates, and technical requirements.

Recommendations for MRI request checklist for rheumatologists

To appropriately inform radiologists, an MRI request from rheumatologists is recommended include a series of items related to clinical information (age, sex, personal and family history, reason for MRI request, suspected, and differential diagnoses) and whether  follow-up MRI is recommended. In addition, safety information (contrast media allergy, renal function, pregnancy, claustrophobia, and metal-containing devices) is recommended be included in the MRI request checklist items.

Recommendations for MRI request template for rheumatologists

To facilitate collaboration and communication between rheumatologists and radiologists, the panel recommended using a template to prepare a spinal and/or sacroiliac joint MRI request among patients with axSpA or axial inflammatory pain. Importantly, information should be included regarding the suspected diagnosis, treatment response, renal function, history of trauma, family history, and extra-articular symptoms that cannot be assessed by MRI.

Recommendations for MRI report checklist of sacroiliac joints

Items to be included on the checklist for an MRI report of sacroiliac joints are designed to provide radiologists with specific information related to technique, potential anatomic variants, and special findings (bone marrow edema, other entheses, visualized lumbosacral union, and other findings) to appropriately assess patients with suspected or confirmed axSpA and/or inflammatory spinal pain.

Recommendations for MRI report template of sacroiliac joints

In the MRI report of sacroiliac joints, the panel recommended that radiologists quantify the number and size of inflammatory lesions (bone marrow edema) and specify the number of consecutive slices in which the lesions are visualized. Radiologists are recommended to indicate if the patient’s hip morphology is normal or dysplastic. If available, recent anteroposterior and lateral x-rays of the lumber spine should be compared with prior x-ray studies.

Recommendations for MRI report checklist of spine

Checklist items for radiologists performing MRI spine assessments in patients with suspected axSpA and/or inflammatory pain is recommended to include information related to technique, intervertebral disc unit (disc, vertebral endplate, vertebral bone marrow, and posterior elements), and other findings (spine fracture or wedging, increased perivertebral soft tissue, spine tumor, myeloma, Scheuermann disease, ochronosis, and others).

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Recommendations for MRI report template of spine

In MRI spine reports, the panel recommended that radiologists provide a description of inflammatory spine lesions using Romanus and Andersson terms, and specify the inflammatory or degenerative origin of the lesion. Radiologists should further quantify the number and location of lesions in the MRI report and compare results with prior imaging studies.

Recommendations for MRI protocols

Consensus on MRI protocols for accurately visualizing sacroiliac joints included the use of axial and coronal planes in which the field of view must include ≥35 cm of the hip anatomy; slice thickness ≤3 mm and gap ≤0.6 mm; matrix ≥320; and b=800 if a diffusion sequence is performed.

For MRI protocols for the spine, the panelists recommended using sagittal and axial planes with possible fat suppression in which the field of view is adjusted to the segment being visualized; slice thickness ≤3 mm and gap ≤0.6 mm; matrix ≥280; and costotransverse joint slices in the sagittal planes of the dorsal segment.

“Combined efforts of rheumatologists and radiologists have produced recommendations for MRI use in rheumatic diseases, including axSpA. However, a joint consensus statement on MRI use in axSpA is still needed, as well as an increased standardization of MRI procedures in axSpA,” the researchers concluded.


Almodovar R, Bueno A, Batlle E, et al. Magnetic resonance imaging assessment in patients with axial spondyloarthritis: development of checklists for use in clinical practice. Rheumatol Int. 2019;39 (12):2119-2127.