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

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.

Automated summary

This opinion article discusses the current use of conventional radiography (CR) in the diagnosis of sacroiliac joint arthritis in adults and juveniles with suspected axial spondyloarthritis (axSpA). Comparisons with magnetic resonance imaging (MRI) and computed tomography (CT) are made, and the advantages and limitations of CR are presented. The article concludes that MRI is more sensitive in detecting early sacroiliitis, while CR remains the method of choice for detecting structural changes in late-stage axSpA or established disease.