MRI Inflammatory Spine limitations

Although there is evidence to suggest that whole-spine, fat-suppressed MRI is increasingly powerful in diagnosing, particularly, early axial-SpA and influencing treatment decisions, it remains clear that MRI is not a panacea. Indeed, it has been widely reported that MRI of the spine, SI joint or both may be ‘negative’ in active axial-SpA and that up to a third of AS patients with ‘negative’ scans still get a major response to anti-TNF. The reasons for these observations remain unclear, although may be due to inadequate resolution of current scanning techniques and hence, their inability to identify existing inflammation or the natural fluctuation in the course of the disease . Either way a negative scan does not necessarily exclude the disease and the new ASAS criteria recognize this by enabling a diagnosis to be made on clinical ± radiographic criteria alone with the exclusion of MRI. However, the MRI capabilities including resolution and sequence development are improving all the time and it is possible that the full spectrum of inflammatory lesions will be visualized in the future. Furthermore, in equivocal cases, a negative MRI scan is highly reassuring that other serious pathologies including malignancy or pathological fractures from other causes are absent.

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