The Imaging Crisis in Axial Spondyloarthritis: Between Early Diagnosis and Overdiagnosis

<p>In this episode of <em>RheumaCast</em>, we dive into the ongoing debate around imaging in axial spondyloarthritis (axSpA). While MRI has revolutionized early detection of sacroiliitis, it has also created new diagnostic challenges. We discuss why bone marrow edema alone is not enough for a confident diagnosis, how mechanical stress and anatomical variations complicate interpretation, and why we might be facing an &quot;imaging crisis&quot; in axSpA.</p><p>We explore current workarounds—pattern recognition, quantification of lesions, contextual interpretation—and their limitations. The conversation also highlights emerging solutions, from advanced imaging techniques and AI-based analysis to the critical role of expert radiology assessment.</p><p>Tune in to understand why balancing early diagnosis with diagnostic accuracy is essential to avoid misclassification, overtreatment, and ultimately to improve patient outcomes.</p><p>This episode is based on the publication: <a href="https://www.sciencedirect.com/science/article/pii/S2665991325001080" target="_blank" rel="noopener noreferer">Diekhoff T, Poddubnyy D, et al. <em>Lancet Rheumatol</em> 2025; Published online May 16, 2025. doi:10.1016/S2665-9913(25)00108-0</a> and developed with NotebookLM.</p>