{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T19:49:00Z","timestamp":1780602540499,"version":"3.54.1"},"reference-count":63,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Musculoskelet Radiol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Sacroiliac joint pathology presents a complex diagnostic challenge due to the diverse range of conditions, both mechanical and inflammatory, that can affect the joint. Although axial spondyloarthritis\u2013related sacroiliitis is often the most recognized pathology, numerous other conditions closely mimic axial spondyloarthritis in both clinical presentation and imaging features. This review describes key anatomical aspects of the sacroiliac joint, including its distinct morphology, ligamentous support, and histologic characteristics, essential for understanding and differentiating various pathologies. It also examines detailed imaging findings from magnetic resonance imaging, computed tomography, and radiography in relation to each pathologic condition. By providing a framework for distinguishing between common and rare sacroiliac joint disorders and axial spondyloarthritis, this article will enhance diagnostic accuracy and offer insights into the anatomical nuances that impact clinical and imaging assessments.<\/jats:p>","DOI":"10.1055\/s-0045-1802971","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T22:36:59Z","timestamp":1743460619000},"page":"210-220","source":"Crossref","is-referenced-by-count":1,"title":["Sacroiliac Joint: Mimics and Pitfalls"],"prefix":"10.1055","volume":"29","author":[{"given":"Mary K. Jesse","family":"Lowry","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Elizabeth","family":"Buchanan","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1213\/01.ANE.0000180831.60169.EA","article-title":"Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment","volume":"101","author":"S P Cohen","year":"2005","journal-title":"Anesth Analg"},{"issue":"02","key":"ref2","first-page":"124","article-title":"Gait analysis of sacroiliac joint patients","volume":"17","author":"W Herzog","year":"1994","journal-title":"J Manipulative Physiol Ther"},{"issue":"217","key":"ref3","first-page":"266","article-title":"Recognizing specific characteristics of nonspecific low back pain","author":"T N Bernard Jr","year":"1987","journal-title":"Clin Orthop Relat Res"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/j.1469-7580.2012.01564.x","article-title":"The sacroiliac joint: an overview of its anatomy, function and potential clinical implications","volume":"221","author":"A Vleeming","year":"2012","journal-title":"J Anat"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1093\/rheumatology\/41.4.375","article-title":"Sacral and iliac articular cartilage thickness and cellularity: relationship to subchondral bone end-plate thickness and cancellous bone density","volume":"41","author":"G J McLauchlan","year":"2002","journal-title":"Rheumatology (Oxford)"},{"issue":"3","key":"ref6","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1055\/s-0034-1375574","article-title":"Anatomy and histology of the sacroiliac joints","volume":"18","author":"N Egund","year":"2014","journal-title":"Semin Musculoskelet Radiol"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/00004728-199903000-00029","article-title":"Sacroiliac joints: anatomical variants on CT","volume":"23","author":"P K Prassopoulos","year":"1999","journal-title":"J Comput Assist Tomogr"},{"issue":"07","key":"ref8","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1007\/s00256-023-04281-z","article-title":"Prevalence of accessory sacroiliac joint anatomy and associated clinical features","volume":"52","author":"T P Trentadue","year":"2023","journal-title":"Skeletal Radiol"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/ajpa.1330220205","article-title":"Accessory sacro-iliac articulations","volume":"22","author":"M Trotter","year":"1937","journal-title":"Am J Phys Anthropol"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.semarthrit.2017.05.009","article-title":"Clinical and imaging mimickers of axial spondyloarthritis","volume":"47","author":"G Slobodin","year":"2017","journal-title":"Semin Arthritis Rheum"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1148\/55.3.403","article-title":"Accessory sacroiliac articulations with arthritic changes","volume":"55","author":"L A Hadley","year":"1950","journal-title":"Radiology"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s11926-021-01033-7","article-title":"Anatomical joint form variation in sacroiliac joint disease: current concepts and new perspectives","volume":"23","author":"K Ziegeler","year":"2021","journal-title":"Curr Rheumatol Rep"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1177\/0284185120930624","article-title":"Diagnostic performance of plain radiography for sacroiliitis in patients with suspected axial spondyloarthritis: a systematic review and metaanalysis","volume":"62","author":"Y Kim","year":"2021","journal-title":"Acta Radiologica"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1136\/annrheumdis-2014-206971","article-title":"EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice","volume":"74","author":"P Mandl","year":"2015","journal-title":"Annals of the Rheumatic Diseases"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"S340","DOI":"10.1016\/j.jacr.2021.08.003","article-title":"Expert panel on musculoskeletal imaging. ACR appropriateness criteria(R) inflammatory back pain: known or suspected axial spondyloarthritis: 2021 update","volume":"18","author":"G J Czuczman","year":"2021","journal-title":"J Am Coll Radiol"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1136\/annrheumdis-2021-220136","article-title":"Choose wisely: imaging for diagnosis of axial spondyloarthritis","volume":"81","author":"T Diekhoff","year":"2022","journal-title":"Annals of the Rheumatic Diseases"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1148\/rg.334125025","article-title":"Sacroiliitis associated with axial spondyloarthropathy: new concepts and latest trends","volume":"33","author":"M Navallas","year":"2013","journal-title":"Radiographics"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"149","DOI":"10.2214\/AJR.12.8858","article-title":"MRI in seronegative spondyloarthritis: imaging features and differential diagnosis in the spine and sacroiliac joints","volume":"200","author":"C Canella","year":"2013","journal-title":"AJR Am J Roentgenol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"iv6","DOI":"10.1093\/rheumatology\/keaa250","article-title":"Classification vs. diagnostic criteria: the challenge of diagnosing axial spondyloarthritis","volume":"59","author":"D. Poddubnyy","year":"2020","journal-title":"Rheumatology"},{"issue":"09","key":"ref20","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1007\/s00256-022-04018-4","article-title":"MRI in axial spondyloarthritis: understanding an \u2018ASAS-positive MRI\u2019 and the ASAS classification criteria","volume":"51","author":"T Diekhoff","year":"2022","journal-title":"Skeletal Radiology"},{"issue":"11","key":"ref21","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1136\/annrheumdis-2019-215589","article-title":"MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group","volume":"78","author":"W P Maksymowych","year":"2019","journal-title":"Annals of the Rheumatic Diseases"},{"issue":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1002\/art.40429","article-title":"Frequency and anatomic distribution of magnetic resonance imaging features in the sacroiliac joints of young athletes: exploring \u201cbackground noise\u201d toward a data-driven definition of sacroiliitis in early spondyloarthritis","volume":"70","author":"U Weber","year":"2018","journal-title":"Arthritis Rheumatol"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1002\/art.40475","article-title":"Magnetic resonance imaging of the sacroiliac joints indicating sacroiliitis according to the Assessment of SpondyloArthritis International Society definition in healthy individuals, runners, and women with postpartum back pain","volume":"70","author":"J de Winter","year":"2018","journal-title":"Arthritis Rheumatol"},{"issue":"08","key":"ref24","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s10067-015-2976-0","article-title":"Peripartum changes of the sacroiliac joints on MRI: increasing mechanical load correlating with signs of edema and inflammation kindling spondyloarthropathy in the genetically prone","volume":"34","author":"I Eshed","year":"2015","journal-title":"Clin Rheumatol"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1002\/art.40718","article-title":"Is it useful to repeat magnetic resonance imaging of the sacroiliac joints after three months or one year in the diagnosis of patients with chronic back pain and suspected axial spondyloarthritis?","volume":"71","author":"P AC Bakker","year":"2019","journal-title":"Arthritis Rheumatol"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1002\/jmri.10073","article-title":"MRI of the pelvic ring joints postpartum: normal and pathological findings","volume":"15","author":"S Wurdinger","year":"2002","journal-title":"J Magn Reson Imaging"},{"issue":"12","key":"ref27","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1007\/s002560050316","article-title":"Pelvic stress injuries: the relationship between osteitis pubis (symphysis pubis stress injury) and sacroiliac abnormalities in athletes","volume":"26","author":"N M Major","year":"1997","journal-title":"Skeletal Radiol"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1007\/s00330-003-1989-2","article-title":"Fatigue stress fractures of the sacrum: diagnosis with MR imaging","volume":"14","author":"J A Ahovuo","year":"2004","journal-title":"Eur Radiol"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jbspin.2015.08.013","article-title":"Sacroiliac joint edema by MRI: far more often mechanical than inflammatory?","volume":"83","author":"J M Berthelot","year":"2016","journal-title":"Joint Bone Spine"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"189","DOI":"10.2214\/ajr.128.2.189","article-title":"Comparison of radiographic abnormalities of the sacroiliac joint in degenerative disease and ankylosing spondylitis","volume":"128","author":"D Resnick","year":"1977","journal-title":"AJR Am J Roentgenol"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1148\/119.3.559","article-title":"Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH)","volume":"119","author":"D Resnick","year":"1976","journal-title":"Radiology"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0049-0172(78)90036-7","article-title":"Diffuse idiopathic skeletal hyperostosis (DISH) [ankylosing hyperostosis of Forestier and Rotes-Querol]","volume":"7","author":"D Resnick","year":"1978","journal-title":"Semin Arthritis Rheum"},{"issue":"03","key":"ref33","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1148\/15.3.513","article-title":"Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations","volume":"115","author":"D Resnick","year":"1975","journal-title":"Radiology"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"271","DOI":"10.4103\/0971-3026.137046","article-title":"Seronegative spondyloarthropathy-related sacroiliitis: CT, MRI features and differentials","volume":"24","author":"D Prakash","year":"2014","journal-title":"Indian J Radiol Imaging"},{"issue":"03","key":"ref35","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s00296-009-1100-7","article-title":"Osteitis condensans ilii","volume":"30","author":"R Mitra","year":"2010","journal-title":"Rheumatol Int"},{"issue":"11","key":"ref36","first-page":"666","article-title":"MRI findings of the sacroiliac joints in patients with low back pain: alternative diagnosis to inflammatory sacroiliitis","volume":"19","author":"I Eshed","year":"2017","journal-title":"Isr Med Assoc J"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/j.1756-185X.2009.01378.x","article-title":"Osteitis condensans ilii: a significant association with sacroiliac joint tenderness in women","volume":"12","author":"K Jenks","year":"2009","journal-title":"Int J Rheum Dis"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1111\/1756-185X.13125","article-title":"Osteitis condensans ilii may demonstrate bone marrow edema on sacroiliac joint magnetic resonance imaging","volume":"21","author":"L Ma","year":"2018","journal-title":"Int J Rheum Dis"},{"issue":"01","key":"ref39","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1186\/s12891-017-1525-1","article-title":"Sacroiliitis mimics: a case report and review of the literature","volume":"18","author":"M J Antonelli","year":"2017","journal-title":"BMC Musculoskelet Disord"},{"issue":"03","key":"ref40","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1093\/rheumatology\/35.3.295-a","article-title":"Osteitis condensans ilii","volume":"35","author":"I Olivieri","year":"1996","journal-title":"Br J Rheumatol"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"3146535","DOI":"10.1155\/2020\/3146535","article-title":"Osseous manifestations of primary hyperparathyroidism: imaging findings","volume":"2020","author":"J Bennett","year":"2020","journal-title":"Int J Endocrinol"},{"issue":"06","key":"ref42","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1148\/rg.2016160004","article-title":"Imaging findings of metabolic bone disease","volume":"36","author":"C Y Chang","year":"2016","journal-title":"Radiographics"},{"issue":"02","key":"ref43","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1148\/118.2.315","article-title":"Subchondral resorption of bone in renal osteodystrophy","volume":"118","author":"D Resnick","year":"1976","journal-title":"Radiology"},{"issue":"01","key":"ref44","doi-asserted-by":"crossref","first-page":"4323","DOI":"10.1038\/s41598-021-83989-1","article-title":"Asymptomatic secondary hyperparathyroidism can mimic sacroiliitis on computed tomography","volume":"11","author":"V Kreutzinger","year":"2021","journal-title":"Sci Rep"},{"key":"ref45","first-page":"99","volume-title":"Pseudogout: presentation, natural history, and associated conditions","author":"A K Rosenthal","year":"2006"},{"issue":"04","key":"ref48","first-page":"477","article-title":"Acute sacroiliitis as a manifestation of calcium pyrophosphate dihydrate crystal deposition disease","volume":"17","author":"A el Maghraoui","year":"1999","journal-title":"Clin Exp Rheumatol"},{"issue":"03","key":"ref49","first-page":"175","article-title":"Sacroiliitis due to calcium pyrophosphate deposition disease","volume":"14","author":"M J Moreno Martinez","year":"2018","journal-title":"Reumatol Clin (Engl Ed)"},{"issue":"02","key":"ref50","doi-asserted-by":"crossref","first-page":"84","DOI":"10.5152\/eurjrheum.2020.19180","article-title":"Two cases of calcium pyrophosphate deposition disease (CPPD) presented with spondylodiscitis","volume":"7","author":"T\u0130 Duran","year":"2020","journal-title":"Eur J Rheumatol"},{"issue":"03","key":"ref51","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.3390\/jcm12031039","article-title":"Diagnostics of sacroiliac joint differentials to axial spondyloarthritis changes by magnetic resonance imaging","volume":"12","author":"A G Jurik","year":"2023","journal-title":"J Clin Med"},{"issue":"03","key":"ref52","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.crad.2011.08.014","article-title":"SAPHO: What radiologists should know","volume":"67","author":"R Depasquale","year":"2012","journal-title":"Clin Radiol"},{"issue":"01","key":"ref53","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1093\/rheumatology\/kel190","article-title":"Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients","volume":"46","author":"A Jansson","year":"2007","journal-title":"Rheumatology (Oxford)"},{"issue":"03","key":"ref54","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.semarthrit.2012.05.006","article-title":"The SAPHO syndrome","volume":"42","author":"M T Nguyen","year":"2012","journal-title":"Semin Arthritis Rheum"},{"issue":"06","key":"ref55","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.semarthrit.2018.09.004","article-title":"Spinal and sacroiliac involvement in SAPHO syndrome: a single center study of a cohort of 354 patients","volume":"48","author":"Y Cao","year":"2019","journal-title":"Semin Arthritis Rheum"},{"issue":"25","key":"ref56","doi-asserted-by":"crossref","first-page":"E1531","DOI":"10.1097\/BRS.0000000000000633","article-title":"Axial gout is frequently associated with the presence of current tophi, although not with spinal symptoms","volume":"39","author":"F M de Mello","year":"2014","journal-title":"Spine"},{"issue":"04","key":"ref57","doi-asserted-by":"crossref","first-page":"216","DOI":"10.5152\/eurjrheum.2019.18097","article-title":"Lower back pain as a manifestation of acute gouty sacroiliitis: utilization of dual-energy computed tomography (DECT) in establishing a diagnosis","volume":"6","author":"R Namas","year":"2019","journal-title":"Eur J Rheumatol"},{"issue":"01","key":"ref58","first-page":"34","article-title":"Dual energy CT: added value in gouty arthritis","volume":"96","author":"J Spermon","year":"2013","journal-title":"JBR-BTR"},{"issue":"06","key":"ref59","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1136\/annrheumdis-2013-205095","article-title":"Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study","volume":"74","author":"T Bongartz","year":"2015","journal-title":"Ann Rheum Dis"},{"issue":"03","key":"ref60","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s00256-013-1771-8","article-title":"The distribution of urate deposition within the extremities in gout: a review of 148 dual-energy CT cases","volume":"43","author":"P I Mallinson","year":"2014","journal-title":"Skeletal Radiol"},{"issue":"02","key":"ref61","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1148\/radiol.11102485","article-title":"Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation","volume":"261","author":"K N Glazebrook","year":"2011","journal-title":"Radiology"},{"issue":"06","key":"ref62","first-page":"1004","article-title":"Septic sacroiliitis: an uncommon septic arthritis","volume":"27","author":"L Mancarella","year":"2009","journal-title":"Clin Exp Rheumatol"},{"issue":"05","key":"ref63","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.2214\/AJR.14.14217","article-title":"Unilateral sacroiliitis: differential diagnosis between infectious sacroiliitis and spondyloarthritis based on MRI findings","volume":"205","author":"Y Kang","year":"2015","journal-title":"AJR Am J Roentgenol"},{"issue":"05","key":"ref64","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1002\/art.10934","article-title":"Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging","volume":"48","author":"B Muche","year":"2003","journal-title":"Arthritis Rheum"},{"issue":"09","key":"ref65","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1002\/1529-0131(200009)43:9<2011::AID-ANR12>3.0.CO;2-Y","article-title":"Histopathologic evidence that sacroiliitis in ankylosing spondylitis is not merely enthesitis","volume":"43","author":"R J Fran\u00e7ois","year":"2000","journal-title":"Arthritis Rheum"}],"container-title":["Seminars in Musculoskeletal Radiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1802971.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T22:53:14Z","timestamp":1743461594000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1802971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":63,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2025,3,31]]},"published-print":{"date-parts":[[2025,4]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0045-1802971","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1089-7860","1098-898X"],"issn-type":[{"value":"1089-7860","type":"print"},{"value":"1098-898X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,31]]}}}