E083 A UK review of the use of MRI in the diagnosis of axial SpA
Authors: Bray Timothy J , Eddison Joe 
Published: April 2023

Abstract

Background/Aims
The National Axial Spondyloarthritis Society (NASS), in collaboration with the British Society for Spondyloarthritis (BRITSpA), sought to understand the current use of and access to MRI in the diagnosis of patients with suspected axial SpA across the UK. They sought to understand if previous inconsistencies in MRI use in clinical practice had improved since the development and publication of a set of recommendations by BRITSpA in 2019.

Methods
NASS used a Freedom of Information (FOI) request to survey all UK NHS Trusts and Health Boards, assessing the use of MRI in the diagnosis of axial spondyloarthritis (axSpA) and radiologists’ awareness and use of the 2019 BRITSpA consensus guidance. Responses from radiology departments, including musculoskeletal radiologists, were compared against those from the 2017 BRITSpA survey to evaluate changes since the 2019 BritSpA guidance.

Results
At the time of submission, full responses had been received from 70 trusts across the UK. 61% of respondents reported MRI wait times less than 2 months, compared to 90% previously. 34% of trusts reported using specialist outsourcing services and 30% reported using non-specialist outsourcing services (these data were not available in the previous survey). 89% of respondents routinely used MRI as a diagnostic test, irrespective of abnormalities detected on plain x-rays; by comparison, in the previous survey only a minority routinely used MRI instead of radiographs and the majority (65%) would only use MRI if specifically requested by rheumatologists. All respondents’ MRI protocol included the sacroiliac joints and some combination of spinal segments, as recommended in the consensus guidelines. The consistency of spinal coverage had increased compared to the previous survey, where 5% reported scanning the SIJs alone. Nearly all respondents (97%) utilised fat-suppressed, water sensitive sequences while 77% used fat-sensitive sequences in line with the recommendations. 79% (SIJs) and 73% (spine) of respondents reported being aware of formal recommendations regarding specific MRI features used in the diagnosis of axSpA. For both anatomical sites, less than half of respondents specifically reported awareness of the recommendations regarding imaging features in the 2019 BRITSpA consensus guidance. Radiologists reported using a variety of radiological features and combinations of features (in both the sacroiliac joints and spine) for diagnosis, but the specific features (and combinations) varied widely.

Conclusion
These data highlight some areas of improvement but also some problematic areas. The routine use of MRI and of recommended MRI protocols have both increased since 2017. However, awareness of the BritSpA consensus guidelines is poor and there is a need to raise awareness of the consensus guidance. Doing so could help to improve consistency, speed and accuracy of diagnosis. The increase in wait times and reliance on outsourcing, including non-specialist services, is a concerning development that warrants further attention.
Disclosure
T.J. Bray: Other; Tim is working with National Axial Spondyloarthritis Society (NASS) as a clinical associate. This project is supported by NASS. J. Eddison: None.