E136 MRI requesting and reporting in axial spondyloarthritis: an audit against the ASAS guidance

Abstract Background/Aims The use of MRI is essential in the diagnosis and management of axial spondyloarthritis (axSpA), due to its ability to demonstrate active inflammation and structural changes in the spine and sacroiliac joints (SIJ). Effective communication between rheumatologists and radiologists is essential to ensuring the correct MRI protocol is utilised, relevant findings are identified and their clinical importance interpreted correctly. Recently, the Assessment of Spondyloarthritis International Society (ASAS) have developed guidelines on requesting and reporting of MRI in suspected axial spondyloarthritis to ensure standardised practice. Aims: To explore current standards of practice at the Leeds Teaching Hospitals NHS Trust (LTHT) in relation to the local inflammatory back pain protocol MRI requests and report against the standards developed by ASAS. Methods We identified all MRIs of the spine and SIJ requested at LTHT between September 2023 and December 2023 under the inflammatory back pain protocol. Report and request data were extracted and analysed against the audit standards. Results In total, 158 MRI requests and reports were identified within the audit period. In terms of requesting data, patient age was included in 11 requests (11.4%), sex in 6 (3.8%) and HLA-B27 in 35 (22.2%). Back pain was recorded in 138 (87.3%), of which location was reported in 72 (45.6%), duration in 30 (18.9%) and inflammatory features in 99 (62.7%). A suspected clinical diagnosis and alternative diagnosis were included in 149 and 27 requests, respectively (94.3% and 17.1%). In terms of the MRI report, bone marrow oedema was mentioned in 128 (81.0%) of reports, if present, the location and semi-quantitative assessment was reported in (97.0% and 89.6%), respectively. Erosions, fat metaplasia and non-axSpA findings were mentioned in 93 (58.5%), 10 (6.3%) and 102 (64.6%) of reports, respectively. Active inflammation was mentioned in 123 (77.8%) and chronic, structural post-inflammatory changes in 82 (51.2%) of reports. Only 98 (62.0%) of reports included a statement as to whether the findings were “in keeping with axSpA”. Conclusion MRI requests for suspected axSpA are missing important clinical and demographic variables which may limit interpretation of the MRI scan by radiologists. Similarly, many MRI reports lack details regarding chronic or structural findings and a significant proportion do not comment on whether findings may be suggestive of axSpA. Further work within the rheumatology and radiology departments to align expectations on requirements regarding both MRI requesting and reporting in axSpA is ongoing, which will be followed by a re-audit. Disclosure J. Weddell: None. H. De Boer: None. J. Wong: None. B. Pass: None. P. Robinson: None. A. Barr: None. C. Vandevelde: None. J. Freeston: None. D. McGonagle: None. H. Marzo-Ortega: None.