{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T15:16:30Z","timestamp":1773760590384,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Assessing structural damage in pediatric sacroiliitis is challenging, necessitating radiation-free alternatives to computed tomography (CT). This study evaluated the diagnostic performance of advanced MRI sequences\u20143D-MENSA (Multi-Echo in Steady-State Acquisition), 3D-MERGE (Multiple-Echo Recombined Gradient Echo), and Zero Echo Time (ZTE)\u2014against conventional T1-weighted sequences for detecting structural lesions. Low-dose computed tomography (LDCT) served as the reference standard. A secondary objective was to qualitatively assess the visibility of active inflammatory lesions and fat metaplasia. Methods: In this cross-sectional study, 23 pediatric patients with enthesitis-related arthritis (ERA) were included. To adhere strictly to radiation safety principles, the study used pre-existing ldCT datasets from a clinical cohort as the reference standard. No new CT scans were performed for this study. Structural lesions (erosions, sclerosis, and joint-space changes) were independently scored by two blinded radiologists. Interobserver agreement was assessed using intraclass correlation coefficients (ICC). Results: Advanced sequences (ZTE, 3D-MENSA, 3D-MERGE) demonstrated high agreement with ldCT for erosion detection (ICC range: 0.924\u20130.998) and significantly outperformed conventional T1-weighted MRI (ICC: 0.707). 3D-MENSA provided distinct contrast, effectively differentiating the ligamentous component of the sacroiliac joint from both the synovial component and the adjacent bone cortex. Qualitatively, 3D-MENSA also identified bone marrow edema and fat metaplasia, which cannot be visualized by ZTE or ldCT. Conclusions: 3D-MENSA and 3D-MERGE enable comprehensive evaluation of structural sacroiliitis lesions in pediatric patients with diagnostic accuracy comparable to ldCT. Specifically, 3D-MENSA demonstrates the potential to detect both active and chronic lesions in a single, rapid, radiation-free acquisition. These findings suggest that it should be considered for routine pediatric imaging protocols.<\/jats:p>","DOI":"10.3390\/diagnostics16060887","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:42:16Z","timestamp":1773751336000},"page":"887","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advanced MRI Sequences for Structural Lesion Assessment in Sacroiliitis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1446-758X","authenticated-orcid":false,"given":"T\u00f6rehan","family":"\u00d6zer","sequence":"first","affiliation":[{"name":"Department Radiology, Kocaeli University, \u0130zmit 41380, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emine Hafize","family":"S\u00f6nmez","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rheumatology, Kocaeli University, \u0130zmit 41380, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonca","family":"Anik","sequence":"additional","affiliation":[{"name":"Department Radiology, Kocaeli University, \u0130zmit 41380, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Clinical examination of the sacroiliacjoint","volume":"28","author":"Liska","year":"2021","journal-title":"J. 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