Semin Musculoskelet Radiol 2023; 27(05): 588-595
DOI: 10.1055/s-0043-1772169
Review Article

Current Role of Conventional Radiography of Sacroiliac Joints in Adults and Juveniles with Suspected Axial Spondyloarthritis: Opinion from the ESSR Arthritis and Pediatric Subcommittees

1   Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
2   Department of Radiology and Nuclear Medicine - Division of Pediatric Radiology, Princess Elisabeth Children's Hospital/Ghent University Hospital, Ghent, Belgium
Anna Zejden
3   Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
Lennart Jans
4   Department of Radiology, Ghent University Hospital, Ghent, Belgium
Chiara Giraudo
5   Department of Medicine – DIMED, University of Padova, Padova, Italy
Mikael Boesen
6   Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
7   Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Fabio Becce
8   Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
9   Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Paolo Simoni
10   Pediatric Imaging Department, Reine Fabiola Children's University Hospital, ULB, Brussels, Belgium
Maria Pilar Aparisi Gómez
11   Department of Radiology, Auckland City Hospital, Auckland District Health Board, Grafton, Auckland, New Zealand
12   Department of Radiology, IMSKE, Valencia, Spain
Jacob Jaremko
13   Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
Mario Maas
14   Department of Radiology & Nuclear Medicine, Amsterdam UMC, location AMC – University of Amsterdam, Amsterdam, Netherlands
15   Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
16   Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
Flavia Menegotto
17   Bristol Royal Hospital for Children Paediatric Radiology Department, University Hospitals Bristol and Weston NHS Foundation Trust (UHBW), Bristol, United Kingdom
18   School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
Monique Reijnierse
19   Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
20   Department of Radiology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, United Kingdom
Winston Rennie
21   Department of Radiology, University Hospitals of Leicester NHS Trust, Loughborough University, Loughborough, United Kingdom
3   Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
› Author Affiliations


This opinion article by the European Society of Musculoskeletal Radiology Arthritis and Pediatric Subcommittees discusses the current use of conventional radiography (CR) of the sacroiliac joints in adults and juveniles with suspected axial spondyloarthritis (axSpA). The strengths and limitations of CR compared with magnetic resonance imaging (MRI) and computed tomography (CT) are presented.

Based on the current literature and expert opinions, the subcommittees recognize the superior sensitivity of MRI to detect early sacroiliitis. In adults, supplementary pelvic radiography, low-dose CT, or synthetic CT may be needed to evaluate differential diagnoses. CR remains the method of choice to detect structural changes in patients with suspected late-stage axSpA or established disease and in patients with suspected concomitant hip or pubic symphysis involvement. In children, MRI is the imaging modality of choice because it can detect active as well as structural changes and is radiation free.

Publication History

Article published online:
10 October 2023

© 2023. Thieme. All rights reserved.

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