What role does imaging play in classifying SpA across different criteria, including X-rays and MRI?

Imaging plays a crucial role in classifying SpA, with different criteria relying on various modalities, primarily X-rays and MRI, each contributing distinctively to diagnosis and classification (Table 1).

Table 1: Role of imaging modalities in the classification of SpA: X-rays vs. MRI

 

Imaging type

Role in SpA classification

Strengths

Limitations

X-rays (conventional radiography)

Detect chronic structural changes in SI joints and spine such as erosions, sclerosis and ankylosis

Widely available, inexpensive, established standard

Low sensitivity in early or nrSpA; interpretative variability

MRI

Detect active inflammatory lesions in SI joints and spine earlier than X-rays

Enables early diagnosis and classification of axSpA; higher sensitivity for early inflammation

Requires expertise; specificity issues in low-prevalence cohorts; standardization ongoing

REFERENCE

  1. Akgul O, Ozgocmen S. Classification criteria for spondyloarthropathies. World J Orthop. 2011 Dec 18;2(12):107-15. doi: 5312/wjo.v2.i12.07. PMID: 22474629; PMCID: PMC3302034.
  2. Dubreuil M, Deodhar AA. Axial spondyloarthritis classification criteria: the debate continues. Curr Opin 2017 Jul;29(4):317-322.
  3. Lipton S, Deodhar A. The new ASAS classification criteria for axial and peripheral spondyloarthritis: promises and pitfalls. International Journal of Clinical Rheumatology. 2012 Dec;7(6):675–82.

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