Table 2: Recommendations for imaging studies in patients with spondyloarthropathy—2006 Meeting of Rheumatology Experts [23].

Level of evidenceGrade of recommendationAgreement among experts (%)

The diagnosis of ankylosing spondylitis requires standard radiographs of the pelvis (anteroposterior view) and lumbar spine (anteroposterior and lateral views including the thoracolumbar junction).2bD92.8
When standard radiographs conclusively demonstrate bilateral sacroiliitis, further imaging studies are not necessary for establishing the diagnosis of ankylosing spondylitis.D90.1
When radiographs are normal or doubtful in a patient with a clinical suspicion of ankylosing spondylitis, diagnostic MRI of the sacroiliac joints is recommended.2aB98.7
MRI of the spine can contribute to the diagnosis of ankylosing spondylitis in patients who have inflammatory back pain with nonsuggestive radiographs of the pelvis and spine.3C98.6
To evaluate entheseal involvement in patients with a clinical suspicion of ankylosing spondylitis, radiographs may be useful and, if needed, Doppler ultrasonography or MRI may deserve to be performed, or radionuclide scanning when multiple entheses are involved.2b/3D81.7
Given the current state of knowledge, imaging methods other than standard radiography are not useful to predict the functional or structural outcome of ankylosing spondylitis.2bD94.4
Given the current state of knowledge, imaging is not appropriate for the routine followup of patients with ankylosing spondylitis. Instead, additional imaging should be performed as dictated by the clinical course.2aC95.1
Given the current state of knowledge, imaging is not recommended for evaluating treatment responses in patients with ankylosing spondylitis.1b/2bC97.1