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Radiographs of the SI joints from patients with axSpA were graded by two rheumatologists independently in two sessions (radiographs only and MRI\u2009+\u2009radiographs) and followed by consensus sessions with the participation of a radiologist. Overall, anteroposterior pelvic radiographs and T1 weighted MR scans of the sacroiliac joints from 138 patients with axSpA were eligible. Intra- and inter-reader reliability was fair to moderate for both techniques regardless of whether they were examined alone or in conjunction with MRI, however confidence levels of readers were relatively higher in the MRI\u2009+\u2009radiographs combined technique compared to radiographs only. Regarding the classification, both readers\u2019 intra and inter reader agreements were moderate to substantial. The kappa values and agreement were notably higher for the combined reading technique. In the consensus sessions, 10.2% of patients were recategorized. Merging the information from MRI scans with pelvic radiographs yielded no notable enhancement in the accuracy of radiographic grading of SI joint. Categorizing axSpA as either radiographic or non-radiographic based on pelvic radiography falls short in reliability even after combining with MR images and may likely call for a more reliable definition, axSpA with or without structural changes, relying on more advanced imaging techniques than radiographs.<\/jats:p>","DOI":"10.1007\/s00296-025-05898-0","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T05:21:10Z","timestamp":1748236870000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of combining magnetic resonance images and radiographs on radiographic grading of sacroiliitis and classification in axial spondyloarthritis: a reliability study"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0673-3961","authenticated-orcid":false,"given":"Kemal","family":"Erol","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8639-751X","authenticated-orcid":false,"given":"Kevser","family":"Orhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8316-1229","authenticated-orcid":false,"given":"I\u015f\u0131l","family":"Yurda\u0131\u015f\u0131k","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4860-452X","authenticated-orcid":false,"given":"Salih","family":"\u00d6zg\u00f6\u00e7men","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"issue":"12","key":"5898_CR1","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, van der El-Zorkany B (2021) Axial spondyloarthritis. 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