This update addresses new developments in imaging of axial spondyloarthritis from the past 5 years. These have focused mostly on enhanced CT and MRI-based technologies that bring greater precision to the assessment of both inflammatory and structural lesions in the sacroiliac joint. An international consensus has recommended a 4-sequence MRI for routine diagnostic evaluation of the sacroiliac joint aimed at depicting the location and extent of inflammation as well as an erosion-sensitive sequence for structural damage. The latter include high resolution thin slice sequences that accentuate the interface between subchondral bone and the overlying cartilage and joint space as well as synthetic CT, a deep learning-based technique that transforms certain MRI sequences into images resembling CT. Algorithms based on deep learning derived from plain radiographic, CT, and MRI datasets are increasingly more accurate at identifying sacroiliitis and individual lesions observed on images of the sacroiliac joints and spine.

Magnetic resonance imaging

Computed tomography

Axial spondyloarthritis

Diagnosis

Prognosis

Sacroiliac joint

Spine

Deep learning

© 2025 The Authors. Published by Elsevier Ltd.