Guidelines for magnetic resonance imaging in axial spondyloarthritis: A Delphi study

Abstract Objective The term axial spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases with a common genetic basis that course with axial and peripheral involvement and enthesitis. Recently, the Assessment of SpondyloArthritis international Society (ASAS) established some diagnostic criteria, including for the first time magnetic resonance imaging (MRI) findings. Given the difficulties of obtaining MRI in some environments and the lack of experience with axial spondyloarthritis, a group of radiologists and rheumatologists sought to establish some practical guidelines to ensure the correct use of MRI in this disease. Material and methods Using the Delphi method, we used a questionnaire with 49 items stratified into 4 blocks to survey 46 experts in the MRI diagnosis of axial spondyloarthritis. Results The experts agreed on 82% of the items. The degree of agreement was 100% in the block “Importance of early diagnosis of axial spondyloarthritis”, 69% in the block “Optimization of the use of MRI in the diagnosis of axial spondyloarthritis”, 93% in the block “Use of MRI in axial spondyloarthritis: Technical aspects”, and 57% in the block “Usefulness of MRI in the prognosis, follow-up, and evaluation of the response to treatment in axial spondyloarthritis”. Conclusions Despite the importance of MRI in the early diagnosis of axial spondyloarthritis, this study shows the need for standardization and points to relative disagreement about how to use MRI in the follow-up of the disease and evaluation of the response to treatment. The results of this study can help improve the use of MRI in axial spondyloarthritis.