Role of whole-body magnetic resonance imaging in diagnosing early spondyloarthritis

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Abstract

Ankylosing spondylitis is the prototypical spondyloarthritis. Early diagnosis has gained clinical importance with the advent of new therapeutic options such as TNF-α inhibitors, which can dramatically improve clinical outcome when initiated early.

Whole-body MRI can contribute important diagnostic information for detecting early forms of spondyloarthritis because it enables evaluation of all important joints that may be involved in the disease process as a one-stop shop modality. MRI allows much more accurate diagnostic evaluation of the thoracic spine, which is affected in the majority of patients.

This article provides an overview of the use of whole-body magnetic resonance imaging (MRI) in the spondyloarthritides. The recommendations given reflect the most recent scientific data and expert opinions. The focus of this review is on MRI findings at both the axial and the appendicular skeleton and the technical feasibility of whole-body MRI in the clinical setting.

Introduction

Whole-body magnetic resonance imaging (MRI) has evolved into an established diagnostic test for a variety of indications in recent years. Dramatic advances in MRI technology and improvements in data processing have made it possible to image the entire human body in a single examination. Only a couple of years ago MRI was still mainly restricted to imaging of specific body regions, largely because of the long examination times compared to other diagnostic modalities such as conventional radiography, computed tomography (CT), nuclear medicine tests, and ultrasonography. State-of-the-art MR scanners and the use of special surface coils, so-called phased-array coils, enable imaging of the entire patient from head to toe without the need for repositioning in between (Fig. 1). To this end, the scanner table is moved either from one imaging level to the next or continuously as with CT. Spatial resolution is the same as in conventional MRI.

Section snippets

Uses of whole-body MRI

Whole-body MRI is used for a variety of diagnostic indications. Numerous studies have investigated its role in searching for metastases in patients with neoplastic disease [1], [2]. Whole-body MRI screening for metastases takes about 15 min using currently available techniques, which is less time-consuming than the traditional combination of ultrasound, conventional radiography, CT, and nuclear medicine tests and does not involve radiation exposure. Another recent MRI technique used in screening

Clinical relevance and summary

Early diagnosis of spondyloarthritis has gained significance for rheumatologists as new medical treatment options have become available. Studies have shown that marked regression of the inflammatory process can be achieved and progression delayed by treatment with TNF-α inhibitors such as infliximab [16], [42], etanercept [43], and adalimumab [44] or interleukin-1 receptor inhibitors such as anakinra [45].

Whole-body MRI can contribute important diagnostic information for detecting early forms

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