Abstract Background/Aims The role of inflammatory protocol magnetic resonance imaging (MRI) of the spine to aid the diagnosis of axial spondyloarthritis (axSpA) is well established. However, the clinical value and optimal timing of repeat MRI scans remain uncertain, both for diagnostic clarity in individuals with risk factors and clinical suspicion for axSpA but negative initial imaging, and for guiding treatment escalation decisions in those with established axSpA. From a healthcare service perspective, our organisation has seen a 39% increase in MRI inflammatory spine requests between 2022 and 2025. This has contributed to system-wide radiology capacity pressures, potentially aggravating MRI waiting times. Identifying opportunities to rationalise the use of repeat imaging could mitigate these pressures. The aim was to evaluate the utility of repeat MRI inflammatory spine scans in patients with known or suspected axSpA, and to assess their impact on clinical management by reviewing clinic letters before and after MRI requests. Methods A retrospective review was performed of patients undergoing ≥2 MRI inflammatory spine scans at a UK national specialist centre between January 2022 and February 2025. Data collected included demographics, clinical features (HLA B27 status, extra-musculoskeletal manifestations), imaging results, reasons for repeat scan, and clinical outcomes. Patients were stratified into the following categories, based on the findings of their initial and repeat imaging: Definite active axSpA, Definite structural features of axSpA, but inactive, Indeterminate changes for axSpA, and No evidence of axSpA. The primary outcome was the proportion of repeat scans influencing clinical management (treatment escalation/de-escalation, discharge, no change). Results Fifty patients (median age 36 years, 76% female) were included; 54% were HLA-B27 negative and 32% had EMMs. The median interval between scans was 499.5 days. - 3 out of 5 patients with active disease on initial MRI demonstrated persistent or new inflammatory changes prompting treatment escalation, while two showed inactive structural changes with no treatment modification. - Among the 39 patients with negative or indeterminate initial imaging, 13% developed new active axSpA on repeat MRI leading to treatment initiation or escalation, whereas 49% were discharged following persistently negative imaging. - Notably, none of the patients with negative initial imaging, HLA-B27 negativity, and no EMMs developed new axSpA changes on repeat MRI and 50% of them were discharged. Conclusion Repeat MRI spines appeared to have limited value in patients with negative initial MRI, HLA-B27 negativity, and no EMMs, none of whom developed new axSpA changes on repeat scans. These findings support consideration of earlier clinical discharge in this subgroup without repeat imaging. This, however, would have only slightly reduced our radiology service pressures, given the small dataset. Further prospective studies would be helpful to validate these findings and refine imaging pathways in axSpA. Disclosure I. Sen: None. J. Kimpton: None. T. Williams: None. R. Sengupta: None. G. Cross: None.
Sen et al. (Wed,) studied this question.