1Dr. Sheikh Muhammad Khan, 2Dr Ali Raza, 3Dr Aman Ullah, 4Dr Muhammad Hafeez, 5Dr Muhammad Yousaf, 6Dr Ashan Ali

MRI Biomarkers for Early Diagnosis of Axial
Spondyloarthritis

Abstract:

The sacroiliac joints and spine are the main areas affected by axial spondyloarthritis
(axSpA), a chronic inflammatory rheumatic illness. Conventional radiographs may appear
normal in the early stages of the disease, making early identification difficult. Active
inflammation and structural abnormalities can be identified by magnetic resonance imaging
(MRI) prior to the development of advanced radiographic alterations. Therefore, a number of
MRI indicators, such as osteitis, bone marrow oedema, erosions, fat metaplasia, backfill, ankylosis, and vertebral corner lesions, may aid in an earlier diagnosis.The purpose of this study
is to assess the diagnostic utility of MRI biomarkers for the early identification of axial
spondyloarthritis and to ascertain the correlation between the clinical diagnosis of axSpA and
certain inflammatory and structural MRI findings.Patients with persistent back pain and a
clinical suspicion of axial spondyloarthritis were included in a prospective observational research. T1-weighted, STIR/T2 fat-suppressed, and diffusion-weighted MRI sequences were used to
examine the sacroiliac joints and, if necessary, the spine. Bone marrow edema/osteitis, erosions, fatty marrow replacement, backfill, ankylosis, and vertebral corner lesions were among the MRI
abnormalities noted. Where available, quantitative diffusion parameters were evaluated, including apparent diffusion coefficient values. HLA-B27 status, inflammatory markers, and
clinical results were recorded. The final clinical diagnosis determined by rheumatological
evaluation was compared with the results of the MRI. Sensitivity, specificity, positive predictive
value, negative predictive value, and overall diagnostic accuracy were used to assess diagnostic
performance.A significant percentage of individuals with suspected early axSpA showed
GlobalHealth & Medicine. 2026; 8(3):263-277. Original Article
DOI:10.35772/ghm.2026.01067
structural and inflammatory abnormalities on MRI. The most common active inflammatory
biomarker and the one with the highest correlation with the clinical diagnosis was sacroiliac joint
bone marrow edema/osteitis. Additional diagnostic information was obtained from erosions and
fatty marrow alterations, especially when they coexisted with active inflammatory lesions. Axial
involvement was also linked to inflammatory lesions in the vertebral corners. Quantitative
diffusion parameters showed promise in distinguishing between anomalies that are inflammatory
and those that are not. Compared to solitary MRI findings, a combination of active and structural
MRI indicators offered better diagnostic discrimination.MRI offers useful biomarkers for the
early detection of axial spondyloarthritis, especially in cases when conventional radiography
yields conflicting results. The primary imaging indicator of ongoing disease is still sacroiliac￾joint bone marrow edema/osteitis; supplementary information is provided by erosions, fatty
metaplasia, and spinal inflammatory lesions. Objective evaluation may be further enhanced by
the use of quantitative MRI methods like DWI and ADC measures. An earlier and more precise
diagnosis of axSpA may be made possible by combining the interpretation of MRI biomarkers
with clinical and laboratory results.

Keywords: ADC; early diagnosis; sacroiliitis; bone marrow oedema; osteitis; diffusion-weighted

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