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When it is not sacroiliitis.

Anthony De Leeuw1, Reda Cherkaoui Jaouad2, Mohamed Kamoun2

  • 1Department of Musculoskeletal Imaging, University of Lille, CHU Lille, 59000, Lille, France. anthony.de.leeuw@ulb.be.

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Summary
This summary is machine-generated.

Magnetic resonance imaging (MRI) of sacroiliac joints (SIJ) detects axial spondyloarthritis (SpA) but can be overdiagnosed. This review details conditions mimicking SIJ inflammation to improve diagnostic accuracy in SpA patients.

Keywords:
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Area of Science:

  • Radiology
  • Rheumatology
  • Orthopedics

Background:

  • Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJ) is crucial for diagnosing early axial spondyloarthritis (SpA).
  • However, imaging findings suggestive of SpA can also be present in numerous other conditions, leading to potential overdiagnosis.
  • Accurate differentiation is essential for appropriate patient management.

Purpose of the Study:

  • To review the key imaging features of common disorders that mimic inflammatory sacroiliitis.
  • To provide a differential diagnosis guide for radiologists and clinicians evaluating SIJ abnormalities.
  • To enhance diagnostic accuracy and reduce the overdiagnosis of axial SpA.

Main Methods:

  • Literature review of conditions presenting with imaging features similar to inflammatory sacroiliitis.
  • Analysis of characteristic MRI findings for each differential diagnosis.
  • Categorization of mimics including mechanical changes, osteoarthritis, osteitis condensans ilii, pregnancy-related changes, anatomical variants, and infectious causes.

Main Results:

  • Mechanical changes and osteoarthritis can present with subchondral edema and sclerosis, mimicking inflammation.
  • Osteitis condensans ilii and pregnancy-related changes show distinct patterns of sclerosis and effusion.
  • Other mimics include infectious sacroiliitis, SAPHO syndrome, hyperparathyroidism, and sacral stress fractures, each with unique imaging characteristics.

Conclusions:

  • Recognizing the imaging features of various SIJ disorders is critical to avoid misinterpreting findings as axial SpA.
  • A comprehensive differential diagnosis approach improves the accuracy of SIJ MRI interpretation.
  • This review aids clinicians in distinguishing true inflammatory sacroiliitis from mimics, optimizing SpA diagnosis and management.