Novel insights into the imaging of axial spondyloarthritis

Axial spondyloarthritis (axSpA) is a chronic immune-mediated disease primarily affecting the sacroiliac joints and spine. Imaging plays a central role in the diagnosis, classification, and disease monitoring of axSpA. In this manuscript, recent developments in imaging that enhance both early detection and the understanding of disease progression are presented and discussed. Key topics include the role of conventional radiographs and their accuracy in the identification of axSpA-related imaging findings, the role of magnetic resonance imaging (MRI) scans or other advanced imaging techniques in identifying inflammatory and structural lesions, and the significance of fat lesions as a marker of postinflammatory changes with the potential to predict new bone formation. Emerging applications of quantitative imaging and artificial intelligence in image analysis are also highlighted. Recent advances in imaging have significantly transformed the diagnostic landscape of axSpA. These insights support the integration of imaging as a biomarker for personalised treatment strategies.