{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T01:31:12Z","timestamp":1790991072515,"version":"4.1.0"},"reference-count":78,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T00:00:00Z","timestamp":1746835200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T00:00:00Z","timestamp":1746835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Skeletal Radiol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Axial spondyloarthritis (axSpA) is a chronic inflammatory condition predominantly affecting the sacroiliac joints and spine. Early and accurate diagnosis is crucial to prevent structural damage and improve patient outcomes. Imaging plays a pivotal role in axSpA diagnosis, monitoring, and clinical trials, offering insights into both inflammatory activity and structural progression. Conventional radiography has been foundational for detecting structural changes, such as syndesmophytes and erosions, but it is limited by poor sensitivity for early disease detection and significant interobserver variability. Advanced imaging modalities, such as magnetic resonance imaging (MRI) and low-dose computed tomography (ld-CT), have emerged as more sensitive tools. MRI excels in identifying active inflammation, particularly bone marrow edema, and is integral to early diagnosis and disease monitoring. ld-CT provides superior spatial resolution for detecting structural lesions while minimizing radiation exposure. However, challenges remain in achieving standardized imaging protocols and consistent scoring systems across clinical trials. Scoring systems like the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Spondyloarthritis Research Consortium of Canada (SPARCC) scores, and Berlin methods require rigorous calibration to ensure reliability. The purpose of this review is to explore the strengths and limitations as well as the use in clinical trials of the different imaging modalities and to offer guidance on selecting the most suitable imaging techniques for assessing both disease activity and structural progression in clinical trials.<\/jats:p>","DOI":"10.1007\/s00256-025-04935-0","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T23:56:39Z","timestamp":1746834999000},"page":"2399-2409","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Imaging in clinical trials of axial spondyloarthritis: what type of imaging should be used"],"prefix":"10.1007","volume":"54","author":[{"given":"Iris","family":"Eshed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6142-3814","authenticated-orcid":false,"given":"Kay Geert A.","family":"Hermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,10]]},"reference":[{"issue":"10089","key":"4935_CR1","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/S0140-6736(16)31591-4","volume":"390","author":"J Sieper","year":"2017","unstructured":"Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73\u201384.","journal-title":"Lancet."},{"issue":"5","key":"4935_CR2","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1136\/ard.61.5.429","volume":"61","author":"A Boonen","year":"2002","unstructured":"Boonen A, van der Heijde D, Landewe R, Spoorenberg A, Schouten H, Rutten-van Molken M, et al. Work status and productivity costs due to ankylosing spondylitis: comparison of three European countries. Ann Rheum Dis. 2002;61(5):429\u201337.","journal-title":"Ann Rheum Dis."},{"issue":"6","key":"4935_CR3","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1136\/annrheumdis-2016-210770","volume":"76","author":"D van der Heijde","year":"2017","unstructured":"van der Heijde D, Ramiro S, Landewe R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978\u201391.","journal-title":"Ann Rheum Dis."},{"issue":"3","key":"4935_CR4","first-page":"230","volume":"186","author":"KG Hermann","year":"2014","unstructured":"Hermann KG, Bollow M. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis: correlation with anatomy and histology. Rofo. 2014;186(3):230\u20137.","journal-title":"Rofo."},{"issue":"12","key":"4935_CR5","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1136\/annrheumdis-2021-221035","volume":"80","author":"V Navarro-Compan","year":"2021","unstructured":"Navarro-Compan V, Sepriano A, El-Zorkany B, van der Heijde D. Axial spondyloarthritis. Ann Rheum Dis. 2021;80(12):1511\u201321.","journal-title":"Ann Rheum Dis."},{"issue":"6 Suppl 28","key":"4935_CR6","first-page":"S178","volume":"20","author":"J Braun","year":"2002","unstructured":"Braun J, Golder W, Bollow M, Sieper J, van der Heijde D. Imaging and scoring in ankylosing spondylitis. Clin Exp Rheumatol. 2002;20(6 Suppl 28):S178-84.","journal-title":"Clin Exp Rheumatol."},{"issue":"2","key":"4935_CR7","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/0049-0172(90)90023-9","volume":"20","author":"MA Khan","year":"1990","unstructured":"Khan MA, van der Linden SM. A wider spectrum of spondyloarthropathies. Semin Arthritis Rheum. 1990;20(2):107\u201313.","journal-title":"Semin Arthritis Rheum."},{"key":"4935_CR8","doi-asserted-by":"crossref","unstructured":"Puhakka KB, Jurik AG, Schiottz-Christensen B, Hansen GV, Egund N, Christiansen JV, et al. Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings. Rheumatology (Oxford). 2004;43(2):234-7.","DOI":"10.1093\/rheumatology\/keh008"},{"issue":"6","key":"4935_CR9","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1007\/s11926-022-01075-5","volume":"24","author":"T Diekhoff","year":"2022","unstructured":"Diekhoff T, Hermann KGA, Lambert RG. Future of low-dose computed tomography and dual-energy computed tomography in axial spondyloarthritis. Curr Rheumatol Rep. 2022;24(6):198\u2013205.","journal-title":"Curr Rheumatol Rep."},{"issue":"1","key":"4935_CR10","doi-asserted-by":"publisher","first-page":"e15014","DOI":"10.1111\/1756-185X.15014","volume":"27","author":"SCW Chan","year":"2024","unstructured":"Chan SCW, Chung HY. MRI for axial SpA: diagnosis, disease activity assessment, and recent advances. Int J Rheum Dis. 2024;27(1):e15014.","journal-title":"Int J Rheum Dis."},{"issue":"1","key":"4935_CR11","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1186\/s12891-022-05609-x","volume":"23","author":"Y Zhang","year":"2022","unstructured":"Zhang Y, Guo Z, Zhan Y, Qu J, Lei X. Evaluation of active inflammation, chronic structural damage, and response to treatment of sacroiliitis in axial spondyloarthritis using the Spondyloarthritis Research Consortium of Canada scoring system. BMC Musculoskelet Disord. 2022;23(1):654.","journal-title":"BMC Musculoskelet Disord."},{"key":"4935_CR12","doi-asserted-by":"crossref","unstructured":"Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68 Suppl 2:ii1-44.","DOI":"10.1136\/ard.2008.104018"},{"issue":"2","key":"4935_CR13","doi-asserted-by":"publisher","first-page":"e002822","DOI":"10.1136\/rmdopen-2022-002822","volume":"8","author":"J Braun","year":"2022","unstructured":"Braun J. Significance of structural changes in the axial skeleton in patients with axial spondyloarthritis: how important are lesions in the sacroiliac joint? RMD Open. 2022;8(2):e002822.","journal-title":"RMD Open."},{"key":"4935_CR14","first-page":"28","volume":"20","author":"J Forestier","year":"1964","unstructured":"Forestier J. Ankylosing spondylitis at the beginning of the century. Rheumatism. 1964;20:28\u201334.","journal-title":"Rheumatism."},{"issue":"7","key":"4935_CR15","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1136\/annrheumdis-2014-206971","volume":"74","author":"P Mandl","year":"2015","unstructured":"Mandl P, Navarro-Compan V, Terslev L, Aegerter P, van der Heijde D, D\u2019Agostino MA, 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\u201339.","journal-title":"Ann Rheum Dis."},{"issue":"2","key":"4935_CR16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s00296-002-0237-4","volume":"23","author":"E Feldtkeller","year":"2003","unstructured":"Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int. 2003;23(2):61\u20136.","journal-title":"Rheumatol Int."},{"issue":"2","key":"4935_CR17","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1136\/annrheumdis-2021-220136","volume":"81","author":"T Diekhoff","year":"2022","unstructured":"Diekhoff T, Eshed I, Radny F, Ziegeler K, Proft F, Greese J, et al. Choose wisely: imaging for diagnosis of axial spondyloarthritis. Ann Rheum Dis. 2022;81(2):237\u201342.","journal-title":"Ann Rheum Dis."},{"issue":"9","key":"4935_CR18","doi-asserted-by":"publisher","first-page":"2403","DOI":"10.1002\/art.38738","volume":"66","author":"R van den Berg","year":"2014","unstructured":"van den Berg R, Lenczner G, Feydy A, van der Heijde D, Reijnierse M, Saraux A, et al. Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR cohort. Arthritis Rheumatol. 2014;66(9):2403\u201311.","journal-title":"Arthritis Rheumatol."},{"issue":"6","key":"4935_CR19","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1136\/ard.62.6.519","volume":"62","author":"A van Tubergen","year":"2003","unstructured":"van Tubergen A, Heuft-Dorenbosch L, Schulpen G, Landewe R, Wijers R, van der Heijde D, et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Ann Rheum Dis. 2003;62(6):519\u201325.","journal-title":"Ann Rheum Dis."},{"issue":"1","key":"4935_CR20","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3899\/jrheum.160079","volume":"44","author":"AA Christiansen","year":"2017","unstructured":"Christiansen AA, Hendricks O, Kuettel D, Horslev-Petersen K, Jurik AG, Nielsen S, et al. Limited reliability of radiographic assessment of sacroiliac joints in patients with suspected early spondyloarthritis. J Rheumatol. 2017;44(1):70\u20137.","journal-title":"J Rheumatol."},{"issue":"9","key":"4935_CR21","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1136\/ard.2003.019968","volume":"63","author":"J Braun","year":"2004","unstructured":"Braun J, Baraliakos X, Golder W, Hermann KG, Listing J, Brandt J, et al. Analysing chronic spinal changes in ankylosing spondylitis: a systematic comparison of conventional X rays with magnetic resonance imaging using established and new scoring systems. Ann Rheum Dis. 2004;63(9):1046\u201355.","journal-title":"Ann Rheum Dis."},{"issue":"1","key":"4935_CR22","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s13244-021-01127-x","volume":"12","author":"G Adelsmayr","year":"2021","unstructured":"Adelsmayr G, Haidmayer A, Spreizer C, Janisch M, Quehenberger F, Klocker E, et al. The value of MRI compared to conventional radiography in analysing morphologic changes in the spine in axial spondyloarthritis. Insights Imaging. 2021;12(1):183.","journal-title":"Insights Imaging."},{"issue":"6","key":"4935_CR23","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1136\/ard.2008.091793","volume":"68","author":"R Landewe","year":"2009","unstructured":"Landewe R, Dougados M, Mielants H, van der Tempel H, van der Heijde D. Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis. 2009;68(6):863\u20137.","journal-title":"Ann Rheum Dis."},{"issue":"4","key":"4935_CR24","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1002\/art.1780270401","volume":"27","author":"S van der Linden","year":"1984","unstructured":"van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361\u20138.","journal-title":"Arthritis Rheum."},{"key":"4935_CR25","doi-asserted-by":"crossref","unstructured":"Creemers MC, Franssen MJ, van\u2019t Hof MA, Gribnau FW, van de Putte LB, van Riel PL. Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis. 2005;64(1):127-9.","DOI":"10.1136\/ard.2004.020503"},{"issue":"1","key":"4935_CR26","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1136\/ard.2010.133645","volume":"70","author":"M Rudwaleit","year":"2011","unstructured":"Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of spondyloarthritis international society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25\u201331.","journal-title":"Ann Rheum Dis."},{"issue":"7","key":"4935_CR27","first-page":"1109","volume":"15","author":"W Mau","year":"1988","unstructured":"Mau W, Zeidler H, Mau R, Majewski A, Freyschmidt J, Stangel W, et al. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol. 1988;15(7):1109\u201314.","journal-title":"J Rheumatol."},{"issue":"3","key":"4935_CR28","doi-asserted-by":"publisher","first-page":"e004400","DOI":"10.1136\/rmdopen-2024-004400","volume":"10","author":"C Lopez-Medina","year":"2024","unstructured":"Lopez-Medina C, Molto A, Sepriano A, Ramiro S, Tournadre A, Dougados M. Sensitivity to change of structural outcomes in axial spondyloarthritis after 10 years of follow up. Data from the DESIR cohort. RMD Open. 2024;10(3):e004400.","journal-title":"RMD Open."},{"issue":"2","key":"4935_CR29","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1002\/acr.24459","volume":"74","author":"A Sepriano","year":"2022","unstructured":"Sepriano A, Ramiro S, van der Heijde D, Dougados M, Claudepierre P, Feydy A, et al. Imaging outcomes for axial spondyloarthritis and sensitivity to change: a five-year analysis of the DESIR cohort. Arthritis Care Res (Hoboken). 2022;74(2):251\u20138.","journal-title":"Arthritis Care Res (Hoboken)."},{"issue":"6","key":"4935_CR30","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1136\/annrheumdis-2022-222747","volume":"82","author":"V Navarro-Compan","year":"2023","unstructured":"Navarro-Compan V, Boel A, Boonen A, Mease PJ, Dougados M, Kiltz U, et al. Instrument selection for the ASAS core outcome set for axial spondyloarthritis. Ann Rheum Dis. 2023;82(6):763\u201372.","journal-title":"Ann Rheum Dis."},{"issue":"9","key":"4935_CR31","doi-asserted-by":"publisher","first-page":"2051","DOI":"10.3899\/jrheum.110423","volume":"38","author":"X Baraliakos","year":"2011","unstructured":"Baraliakos X, van der Heijde D, Braun J, Landewe RB. OMERACT magnetic resonance imaging initiative on structural and inflammatory lesions in ankylosing spondylitis\u2013report of a special interest group at OMERACT 10 on sacroiliac joint and spine lesions. J Rheumatol. 2011;38(9):2051\u20134.","journal-title":"J Rheumatol."},{"issue":"6","key":"4935_CR32","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.2214\/AJR.05.1423","volume":"187","author":"MA Bredella","year":"2006","unstructured":"Bredella MA, Steinbach LS, Morgan S, Ward M, Davis JC. MRI of the sacroiliac joints in patients with moderate to severe ankylosing spondylitis. AJR Am J Roentgenol. 2006;187(6):1420\u20136.","journal-title":"AJR Am J Roentgenol."},{"issue":"10","key":"4935_CR33","doi-asserted-by":"publisher","first-page":"4778","DOI":"10.1093\/rheumatology\/keab099","volume":"60","author":"WP Maksymowych","year":"2021","unstructured":"Maksymowych WP, Lambert RG, Baraliakos X, Weber U, Machado PM, Pedersen SJ, et al. Data-driven definitions for active and structural MRI lesions in the sacroiliac joint in spondyloarthritis and their predictive utility. Rheumatology (Oxford). 2021;60(10):4778\u201389.","journal-title":"Rheumatology (Oxford)."},{"key":"4935_CR34","doi-asserted-by":"publisher","first-page":"1628","DOI":"10.1136\/ard-2024-225882","volume":"83","author":"RGW Lambert","year":"2024","unstructured":"Lambert RGW, Baraliakos X, Bernard SA, Carrino JA, Diekhoff T, Eshed I, et al. Development of international consensus on a standardised image acquisition protocol for diagnostic evaluation of the sacroiliac joints by MRI: an ASAS-SPARTAN collaboration. Ann Rheum Dis. 2024;83:1628\u201335.","journal-title":"Ann Rheum Dis."},{"key":"4935_CR35","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-024-04812-2","author":"A Massignan","year":"2024","unstructured":"Massignan A, Knabben MM, da Silva TB, Hohgraefe NG. Review of the updated definitions and concepts of spinal lesions in axial spondyloarthritis. Skeletal Radiol. 2024. https:\/\/doi.org\/10.1007\/s00256-024-04812-2.","journal-title":"Skeletal Radiol."},{"issue":"8","key":"4935_CR36","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1136\/ard.2011.150680","volume":"71","author":"KG Hermann","year":"2012","unstructured":"Hermann KG, Baraliakos X, van der Heijde DM, Jurik AG, Landewe R, Marzo-Ortega H, et al. Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS\/OMERACT MRI study group. Ann Rheum Dis. 2012;71(8):1278\u201388.","journal-title":"Ann Rheum Dis."},{"issue":"6","key":"4935_CR37","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1136\/ard.2009.108217","volume":"68","author":"M Rudwaleit","year":"2009","unstructured":"Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770\u20136.","journal-title":"Ann Rheum Dis."},{"issue":"6","key":"4935_CR38","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1136\/ard.2009.108233","volume":"68","author":"M Rudwaleit","year":"2009","unstructured":"Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777\u201383.","journal-title":"Ann Rheum Dis."},{"issue":"10","key":"4935_CR39","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1136\/ard.2009.110767","volume":"68","author":"M Rudwaleit","year":"2009","unstructured":"Rudwaleit M, Jurik AG, Hermann KG, Landewe R, van der Heijde D, Baraliakos X, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS\/OMERACT MRI group. Annals Rheumat Dis. 2009;68(10):1520\u20137.","journal-title":"Annals Rheumat Dis"},{"issue":"11","key":"4935_CR40","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.1136\/annrheumdis-2014-205432","volume":"74","author":"R van den Berg","year":"2015","unstructured":"van den Berg R, Lenczner G, Thevenin F, Claudepierre P, Feydy A, Reijnierse M, et al. Classification of axial SpA based on positive imaging (radiographs and\/or MRI of the sacroiliac joints) by local rheumatologists or radiologists versus central trained readers in the DESIR cohort. Ann Rheum Dis. 2015;74(11):2016\u201321.","journal-title":"Ann Rheum Dis."},{"issue":"11","key":"4935_CR41","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1136\/annrheumdis-2015-208642","volume":"75","author":"RG Lambert","year":"2016","unstructured":"Lambert RG, Bakker PA, van der Heijde D, Weber U, Rudwaleit M, Hermann KG, et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis. 2016;75(11):1958\u201363.","journal-title":"Ann Rheum Dis."},{"issue":"4","key":"4935_CR42","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/S0889-857X(05)70038-7","volume":"24","author":"J Braun","year":"1998","unstructured":"Braun J, Bollow M, Sieper J. Radiologic diagnosis and pathology of the spondyloarthropathies. Rheum Dis Clin North Am. 1998;24(4):697\u2013735.","journal-title":"Rheum Dis Clin North Am."},{"issue":"5","key":"4935_CR43","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1002\/art.21445","volume":"53","author":"WP Maksymowych","year":"2005","unstructured":"Maksymowych WP, Inman RD, Salonen D, Dhillon SS, Williams M, Stone M, et al. Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum. 2005;53(5):703\u20139.","journal-title":"Arthritis Rheum."},{"issue":"1","key":"4935_CR44","doi-asserted-by":"publisher","first-page":"79","DOI":"10.3899\/jrheum.140519","volume":"42","author":"WP Maksymowych","year":"2015","unstructured":"Maksymowych WP, Wichuk S, Chiowchanwisawakit P, Lambert RG, Pedersen SJ. Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score. J Rheumatol. 2015;42(1):79\u201386.","journal-title":"J Rheumatol."},{"issue":"3","key":"4935_CR45","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1007\/s00117-003-0992-6","volume":"44","author":"KG Hermann","year":"2004","unstructured":"Hermann KG, Braun J, Fischer T, Reisshauer H, Bollow M. Magnetic resonance tomography of sacroiliitis: anatomy, histological pathology, MR-morphology, and grading. Radiologe. 2004;44(3):217\u201328.","journal-title":"Radiologe."},{"issue":"6","key":"4935_CR46","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1136\/annrheumdis-2012-201545","volume":"72","author":"CE Althoff","year":"2013","unstructured":"Althoff CE, Sieper J, Song IH, Haibel H, Weiss A, Diekhoff T, et al. Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI. Ann Rheum Dis. 2013;72(6):967\u201373.","journal-title":"Ann Rheum Dis."},{"issue":"5","key":"4935_CR47","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.2214\/AJR.17.19429","volume":"212","author":"VG Swami","year":"2019","unstructured":"Swami VG, Jaremko JL, Rumsey DG, Stimec J, Tse SML, Otobo TM, et al. Diagnostic accuracy of MRI-based sacroiliitis scoring systems: a systematic review. AJR Am J Roentgenol. 2019;212(5):1112\u201325.","journal-title":"AJR Am J Roentgenol."},{"issue":"4","key":"4935_CR48","first-page":"862","volume":"34","author":"C Lukas","year":"2007","unstructured":"Lukas C, Braun J, van der Heijde D, Hermann KG, Rudwaleit M, Ostergaard M, et al. Scoring inflammatory activity of the spine by magnetic resonance imaging in ankylosing spondylitis: a multireader experiment. J Rheumatol. 2007;34(4):862\u201370.","journal-title":"J Rheumatol."},{"issue":"9","key":"4935_CR49","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1136\/ard.2007.073098","volume":"67","author":"M Rudwaleit","year":"2008","unstructured":"Rudwaleit M, Schwarzlose S, Hilgert ES, Listing J, Braun J, Sieper J. MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Ann Rheum Dis. 2008;67(9):1276\u201381.","journal-title":"Ann Rheum Dis."},{"issue":"4","key":"4935_CR50","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1002\/art.10883","volume":"48","author":"J Braun","year":"2003","unstructured":"Braun J, Baraliakos X, Golder W, Brandt J, Rudwaleit M, Listing J, et al. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum. 2003;48(4):1126\u201336.","journal-title":"Arthritis Rheum."},{"issue":"9","key":"4935_CR51","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1136\/ard.2004.032441","volume":"64","author":"M Rudwaleit","year":"2005","unstructured":"Rudwaleit M, Baraliakos X, Listing J, Brandt J, Sieper J, Braun J. Magnetic resonance imaging of the spine and the sacroiliac joints in ankylosing spondylitis and undifferentiated spondyloarthritis during treatment with etanercept. Ann Rheum Dis. 2005;64(9):1305\u201310.","journal-title":"Ann Rheum Dis."},{"issue":"4","key":"4935_CR52","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1002\/art.21337","volume":"53","author":"WP Maksymowych","year":"2005","unstructured":"Maksymowych WP, Inman RD, Salonen D, Dhillon SS, Krishnananthan R, Stone M, et al. Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis. Arthritis Rheum. 2005;53(4):502\u20139.","journal-title":"Arthritis Rheum."},{"issue":"4","key":"4935_CR53","first-page":"871","volume":"34","author":"D van der Heijde","year":"2007","unstructured":"van der Heijde D, Landewe R, Hermann KG, Rudwaleit M, Ostergaard M, Oostveen A, et al. Is there a preferred method for scoring activity of the spine by magnetic resonance imaging in ankylosing spondylitis? J Rheumatol. 2007;34(4):871\u20133.","journal-title":"J Rheumatol."},{"issue":"3","key":"4935_CR54","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1002\/art.22627","volume":"57","author":"WP Maksymowych","year":"2007","unstructured":"Maksymowych WP, Dhillon SS, Park R, Salonen D, Inman RD, Lambert RG. Validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging spinal inflammation index: is it necessary to score the entire spine? Arthritis Rheum. 2007;57(3):501\u20137.","journal-title":"Arthritis Rheum."},{"issue":"8","key":"4935_CR55","doi-asserted-by":"publisher","first-page":"1728","DOI":"10.3899\/jrheum.091043","volume":"37","author":"Maksymowych WP, Salonen D, Inman RD, Rahman P, Lambert RG, Group CS","year":"2010","unstructured":"Maksymowych WP, Salonen D, Inman RD, Rahman P, Lambert RG, Group CS. Low-dose infliximab (3 mg\/kg) significantly reduces spinal inflammation on magnetic resonance imaging in patients with ankylosing spondylitis: a randomized placebo-controlled study. J Rheumatol. 2010;37(8):1728\u201334.","journal-title":"J Rheumatol."},{"issue":"2","key":"4935_CR56","doi-asserted-by":"publisher","first-page":"e001057","DOI":"10.1136\/rmdopen-2019-001057","volume":"5","author":"S Krabbe","year":"2019","unstructured":"Krabbe S, Ostergaard M, Pedersen SJ, Weber U, Krober G, Makysmowych W, et al. Canada-Denmark MRI scoring system of the spine in patients with axial spondyloarthritis: updated definitions, scoring rules and inter-reader reliability in a multiple reader setting. RMD Open. 2019;5(2):e001057.","journal-title":"RMD Open."},{"issue":"5","key":"4935_CR57","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1002\/art.33466","volume":"64","author":"V Devauchelle-Pensec","year":"2012","unstructured":"Devauchelle-Pensec V, D\u2019Agostino MA, Marion J, Lapierre M, Jousse-Joulin S, Colin D, et al. Computed tomography scanning facilitates the diagnosis of sacroiliitis in patients with suspected spondylarthritis: results of a prospective multicenter French cohort study. Arthritis Rheum. 2012;64(5):1412\u20139.","journal-title":"Arthritis Rheum."},{"issue":"3","key":"4935_CR58","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s10067-011-1871-6","volume":"31","author":"G Slobodin","year":"2012","unstructured":"Slobodin G, Croitoru S, Starikov N, Younis S, Boulman N, Rimar D, et al. Incidental computed tomography sacroiliitis: clinical significance and inappropriateness of the New York radiological grading criteria for the diagnosis. Clin Rheumatol. 2012;31(3):425\u20138.","journal-title":"Clin Rheumatol."},{"issue":"9","key":"4935_CR59","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1136\/annrheumdis-2016-210640","volume":"76","author":"T Diekhoff","year":"2017","unstructured":"Diekhoff T, Hermann KG, Greese J, Schwenke C, Poddubnyy D, Hamm B, et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis. 2017;76(9):1502\u20138.","journal-title":"Ann Rheum Dis."},{"issue":"5","key":"4935_CR60","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.2214\/AJR.18.19678","volume":"211","author":"BS Chahal","year":"2018","unstructured":"Chahal BS, Kwan ALC, Dhillon SS, Olubaniyi BO, Jhiangri GS, Neilson MM, et al. Radiation exposure to the sacroiliac joint from low-dose CT compared with radiography. AJR Am J Roentgenol. 2018;211(5):1058\u201362.","journal-title":"AJR Am J Roentgenol."},{"issue":"3","key":"4935_CR61","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1136\/annrheumdis-2017-212553","volume":"77","author":"F de Bruin","year":"2018","unstructured":"de Bruin F, de Koning A, van den Berg R, Baraliakos X, Braun J, Ramiro S, et al. Development of the CT Syndesmophyte Score (CTSS) in patients with ankylosing spondylitis: data from the SIAS cohort. Ann Rheum Dis. 2018;77(3):371\u20137.","journal-title":"Ann Rheum Dis."},{"issue":"12","key":"4935_CR62","doi-asserted-by":"publisher","first-page":"1828","DOI":"10.3899\/jrheum.170340","volume":"44","author":"S Tan","year":"2017","unstructured":"Tan S, Yao L, Ward MM. Thoracic syndesmophytes commonly occur in the absence of lumbar syndesmophytes in ankylosing spondylitis: a computed tomography study. J Rheumatol. 2017;44(12):1828\u201332.","journal-title":"J Rheumatol."},{"issue":"6","key":"4935_CR63","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1136\/ard-2023-225444","volume":"83","author":"ST Willesen","year":"2024","unstructured":"Willesen ST, Hadsbjerg AE, Moller JM, Vladimirova N, Vora BMK, Seven S, et al. MRI-based synthetic CT: a new method for structural damage assessment in the spine in patients with axial spondyloarthritis - a comparison with low-dose CT and radiography. Ann Rheum Dis. 2024;83(6):807\u201315.","journal-title":"Ann Rheum Dis."},{"issue":"4","key":"4935_CR64","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1007\/s10067-019-04824-7","volume":"39","author":"L Ye","year":"2020","unstructured":"Ye L, Liu Y, Xiao Q, Dong L, Wen C, Zhang Z, et al. MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis. Clin Rheumatol. 2020;39(4):1295\u2013303.","journal-title":"Clin Rheumatol."},{"issue":"2","key":"4935_CR65","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1136\/annrheumdis-2017-211989","volume":"77","author":"A de Koning","year":"2018","unstructured":"de Koning A, de Bruin F, van den Berg R, Ramiro S, Baraliakos X, Braun J, et al. Low-dose CT detects more progression of bone formation in comparison to conventional radiography in patients with ankylosing spondylitis: results from the SIAS cohort. Ann Rheum Dis. 2018;77(2):293\u20139.","journal-title":"Ann Rheum Dis."},{"issue":"1","key":"4935_CR66","first-page":"125","volume":"31","author":"A Spoorenberg","year":"2004","unstructured":"Spoorenberg A, de Vlam K, van der Linden S, Dougados M, Mielants H, van de Tempel H, et al. Radiological scoring methods in ankylosing spondylitis. Reliability and change over 1 and 2 years. J Rheumatol. 2004;31(1):125\u201332.","journal-title":"J Rheumatol."},{"issue":"8","key":"4935_CR67","doi-asserted-by":"publisher","first-page":"2622","DOI":"10.1002\/art.20446","volume":"50","author":"AJ Wanders","year":"2004","unstructured":"Wanders AJ, Landewe RB, Spoorenberg A, Dougados M, van der Linden S, Mielants H, et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the outcome measures in rheumatology clinical trials filter. Arthritis Rheum. 2004;50(8):2622\u201332.","journal-title":"Arthritis Rheum."},{"issue":"6","key":"4935_CR68","first-page":"883","volume":"31","author":"L Carmona","year":"2013","unstructured":"Carmona L, Sellas A, Rodriguez-Lozano C, Juanola X, Garcia Llorente JF, Fernandez Sueiro JL, et al. Scoring with the Berlin MRI method for assessment of spinal inflammatory activity in patients with ankylosing spondylitis: a calibration exercise among rheumatologists. Clin Exp Rheumatol. 2013;31(6):883\u20138.","journal-title":"Clin Exp Rheumatol."},{"issue":"Suppl 3","key":"4935_CR69","first-page":"405","volume":"71","author":"W Maksymowych","year":"2013","unstructured":"Maksymowych W, Learch T, Lambert R, Ward M, Haroon N, Salonen D, et al. FRI0271 The SPARCC\/SPARTAN (SPAR) reference imaging module for calibration of readers scoring with the msasss: preliminary validation. Annals Rheumat Dis. 2013;71(Suppl 3):405.","journal-title":"Annals Rheumat Dis."},{"issue":"8","key":"4935_CR70","doi-asserted-by":"publisher","first-page":"1666","DOI":"10.3899\/jrheum.120131","volume":"39","author":"WP Maksymowych","year":"2012","unstructured":"Maksymowych WP, Lambert RG, Brown LS, Pangan AL. Defining the minimally important change for the Spondyloarthritis Research Consortium of Canada spine and sacroiliac joint magnetic resonance imaging indices for ankylosing spondylitis. J Rheumatol. 2012;39(8):1666\u201374.","journal-title":"J Rheumatol."},{"issue":"12","key":"4935_CR71","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1007\/s11926-022-01091-5","volume":"24","author":"AS De Craemer","year":"2022","unstructured":"De Craemer AS, Lukasik Z, Carron P. Use of imaging in axial spondyloarthritis for diagnosis and assessment of disease remission in the year 2022. Curr Rheumatol Rep. 2022;24(12):383\u201397.","journal-title":"Curr Rheumatol Rep."},{"key":"4935_CR72","doi-asserted-by":"publisher","first-page":"110793","DOI":"10.1016\/j.ejrad.2023.110793","volume":"163","author":"T Martin-Noguerol","year":"2023","unstructured":"Martin-Noguerol T, Casado-Verdugo OL, Beltran LS, Aguilar G, Luna A. Role of advanced MRI techniques for sacroiliitis assessment and quantification. Eur J Radiol. 2023;163:110793.","journal-title":"Eur J Radiol."},{"issue":"1","key":"4935_CR73","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s41747-020-00174-1","volume":"4","author":"G Aringhieri","year":"2020","unstructured":"Aringhieri G, Zampa V, Tosetti M. Musculoskeletal MRI at 7 T: do we need more or is it more than enough? Eur Radiol Exp. 2020;4(1):48.","journal-title":"Eur Radiol Exp."},{"issue":"8","key":"4935_CR74","doi-asserted-by":"publisher","first-page":"5578","DOI":"10.1007\/s00330-023-09511-5","volume":"33","author":"A Rau","year":"2023","unstructured":"Rau A, Straehle J, Stein T, Diallo T, Rau S, Faby S, et al. Photon-counting computed tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose. Eur Radiol. 2023;33(8):5578\u201386.","journal-title":"Eur Radiol."},{"key":"4935_CR75","doi-asserted-by":"publisher","first-page":"1280266","DOI":"10.3389\/fmed.2023.1280266","volume":"10","author":"AI Nicoara","year":"2023","unstructured":"Nicoara AI, Sas LM, Bita CE, Dinescu SC, Vreju FA. Implementation of artificial intelligence models in magnetic resonance imaging with focus on diagnosis of rheumatoid arthritis and axial spondyloarthritis: narrative review. Front Med (Lausanne). 2023;10:1280266.","journal-title":"Front Med (Lausanne)."},{"issue":"3","key":"4935_CR76","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1148\/radiol.212526","volume":"305","author":"KK Bressem","year":"2022","unstructured":"Bressem KK, Adams LC, Proft F, Hermann KGA, Diekhoff T, Spiller L, et al. Deep learning detects changes indicative of axial spondyloarthritis at MRI of sacroiliac joints. Radiology. 2022;305(3):655\u201365.","journal-title":"Radiology."},{"key":"4935_CR77","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1136\/ard-2024-225862","volume":"84","author":"J Nicolaes","year":"2024","unstructured":"Nicolaes J, Tselenti E, Aouad T, Lopez-Medina C, Feydy A, Talbot H, et al. Performance analysis of a deep-learning algorithm to detect the presence of inflammation in MRI of sacroiliac joints in patients with axial spondyloarthritis. Ann Rheum Dis. 2024;84:60\u20137.","journal-title":"Ann Rheum Dis."},{"issue":"4","key":"4935_CR78","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1007\/s10067-019-04803-y","volume":"39","author":"YB Joo","year":"2020","unstructured":"Joo YB, Baek IW, Park YJ, Park KS, Kim KJ. Machine learning-based prediction of radiographic progression in patients with axial spondyloarthritis. Clin Rheumatol. 2020;39(4):983\u201391.","journal-title":"Clin Rheumatol."}],"container-title":["Skeletal Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00256-025-04935-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00256-025-04935-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00256-025-04935-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T10:04:43Z","timestamp":1758708283000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00256-025-04935-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,10]]},"references-count":78,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["4935"],"URL":"https:\/\/doi.org\/10.1007\/s00256-025-04935-0","relation":{},"ISSN":["0364-2348","1432-2161"],"issn-type":[{"value":"0364-2348","type":"print"},{"value":"1432-2161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,10]]},"assertion":[{"value":"15 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 May 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"IE: None. KGH: Lecture fees from Novartis, Pfizer, UCB, and Eli Lilly. Co-founder of BerlinFlame GmbH.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}