MRI in Spondyloarthritis

  • Paola D’Aprile
  • Alfredo Tarantino


MRI represents a fundamental technique in the diagnosis of spondyloarthritis and the gold standard technique to detect early changes of the disease.

MR findings of spondyloarthritis are typical but not specific. It is mandatory that an efficient imaging protocol is needed.

Typical lesions in spondyloarthritis comprise: spondylitis, discitis, spondylodiscitis, sacroiliitis, osteoarthritis (of the facet joints, costovertebral, and costotrasverse joints), and enthesitis.

Lesions may be acute (i.e., bone marrow edema—osteitis, synovitis, capsulitis, enthesitis) or chronic (i.e., osteosclerosis, bone erosions, fat deposition, bony bridges/ankylosis).

MRI clearly detects all the above mentioned changes. In particular, bone marrow edema appears as hyperintense on T2-weighted images with Fat Saturation and STIR images. Contrast enhancement of the cancellous bone indicates osteitis. Contrast enhancement of synovia, joint capsule, and ligaments indicates, respectively, synovitis, capsulitis, and enthesitis.


  1. 1.
    Baraliakos X, Landewé R, Hermann KG, et al. Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging. Ann Rheum Dis. 2005;64(5):730–4.CrossRefGoogle Scholar
  2. 2.
    Bollow M, Enzweiler C, Taupitz M, et al. Use of contrast enhanced magnetic resonance imaging to detect spinal inflammation in patients with spondyloarthritides. Clin Exp Rheumatol. 2002;20(Suppl 28):S167–74.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Bochkova AG, Levshakova AV, Bunchuk NV, et al. Spinal inflammation lesions as detected by magnetic resonance imaging in patients with early ankylosing spondylitis are more often observed in posterior structures of the spine. Rheumatology (Oxford). 2010;49(4):749–55.CrossRefGoogle Scholar
  4. 4.
    Hermann KG, Althoff CE, Schneider U, et al. Spinal changes in patients with spondyloarthritis: comparison of MR imaging and radiographic appearances. Radiographics. 2005;25(3):559–69; discussion 569–570.CrossRefGoogle Scholar
  5. 5.
    Hermann KG, Bollow M. Magnetic resonance imaging of the axial skeleton in rheumatoid disease. Best Pract Res Clin Rheumatol. 2004;18(6):881–907.CrossRefGoogle Scholar
  6. 6.
    Jevtic V. Magnetic resonance imaging appearances of different discovertebral lesions. Eur Radiol. 2001;11:1123–35.CrossRefGoogle Scholar
  7. 7.
    Lambert RGW, Pedersen SJ, Maksymowych W, Maksymowych WP, et al. Active inflammatory lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis—definitions, assessment system, and reference image set. J Rheumatol. 2009;84(Suppl 12):3–17. Scholar
  8. 8.
    Maksymowych WP, Crowther SM, Dhillon SS, et al. Systematic assessment of inflammation by magnetic resonance imaging in the posterior elements of the spine in ankylosing spondylitis. Arthritis Care Res (Hoboken). 2010;62(1):4–10.CrossRefGoogle Scholar
  9. 9.
    Weber U, Pfirrmann CW, Kissling RO, et al. 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;8:20.CrossRefGoogle Scholar
  10. 10.
    Zochling J, Baraliakos X, Hermann K-G, et al. Magnetic resonance imaging in ankylosing spondylitis. Curr Opin Rheumatol. 2007;19(4):346–52. Scholar
  11. 11.
    Romanus R, Yden S. Destructive and ossifying spondylitic changes in rheumatoid ankylosing spondylitis. Acta Orthop Scand. 1952;22:88–99.CrossRefGoogle Scholar
  12. 12.
    Andersson O. Rontgenbilden vid spondylarthris ankylopoetica. Nord Med Tidskr. 1937;14:2000–3.Google Scholar
  13. 13.
    Dihlmann W, Delling G. Disco-vertebral destructive lesions (so called Andersson lesions) associated with ankylosing spondylitis. Skeletal Radiol. 1978;3:10–5.CrossRefGoogle Scholar
  14. 14.
    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:ii1–ii44. Scholar
  15. 15.
    Tarantino A, Jablonska JP, D’Aprile P. All that glitters is not gold: sacroiliitis. Reumatologia. 2018;56(5):289–93.CrossRefGoogle Scholar
  16. 16.
    Berthelot JM, le Goff B, Maugars Y, et al. Sacroiliac joint edema by MRI: far more often mechanical than inflammatory? Joint Bone Spine. 2016;83:3–5.CrossRefGoogle Scholar
  17. 17.
    Pialat JB, Di Marco L, Feydy A, et al. Sacroiliac joint imaging in axial spondyloarthritis. Diagn Interv Imaging. 2016;97:697–708.CrossRefGoogle Scholar

Suggested Readings

  1. Amrami KK. Imaging of the seronegative spondyloarthropathies. Radiol Clin North Am. 2012;50(4):841–54.CrossRefGoogle Scholar
  2. Guglielmi G, Miller FH. Imaging of rheumatology. Radiol Clin North Am. 2017;55(5).Google Scholar
  3. Mandl P, Navarro-Compán V, Terslev L, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015;74(7):1327–39.CrossRefGoogle Scholar
  4. Ostergaard M, Lambert RG. Imaging in ankylosing spondylitis. Ther Adv Musculoskelet Dis. 2012;4(4):301–11.CrossRefGoogle Scholar
  5. Schueller-Weidekamm C, Mascarenhas VV, Sudol-Szopinska I, et al. Imaging and interpretation of axial spondyloarthritis: the radiologist’s perspective-consensus of the Arthritis Subcommittee of the ESSR. Semin Musculoskelet Radiol. 2014;18(3):265–79.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Paola D’Aprile
    • 1
  • Alfredo Tarantino
    • 1
  1. 1.Radiology - Neuroradiology SectionSan Paolo HospitalBariItaly

Personalised recommendations