Musculoskeletal imaging: early sacroiliitis: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Musculoskeletal imaging: early sacroiliitis

Sample item

A 24-year-old man has inflammatory back pain for four months with normal sacroiliac joint radiographs. Which investigation can show the earliest changes of sacroiliitis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. MRI with STIR sequences

MRI with fat-suppressed STIR sequences shows bone marrow oedema, the earliest sign of active sacroiliitis, years before radiographic erosions. Radiographs show later changes such as erosions and sclerosis. Bone scans lack specificity and ultrasound cannot image the deep joint.

Option by option

  • A. Repeat plain radiograph at six weeks

    Repeating the plain film would remain normal until structural damage develops.

  • B. Ultrasound of the sacroiliac joint

    Ultrasound cannot evaluate the deep synovial and cartilaginous joint.

  • C. MRI with STIR sequences (correct)

    Correct. STIR MRI reveals marrow oedema before structural change appears on radiographs.

  • D. Technetium bone scan with SPECT

    Bone scintigraphy is non-specific and poorly sensitive for early sacroiliitis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, MRI with STIR sequences. MRI with fat-suppressed STIR sequences shows bone marrow oedema, the earliest sign of active sacroiliitis, years before radiographic erosions.

Why is "Repeat plain radiograph at six weeks" not the answer?

Repeating the plain film would remain normal until structural damage develops.

Why is "Ultrasound of the sacroiliac joint" not the answer?

Ultrasound cannot evaluate the deep synovial and cartilaginous joint.

Why is "Technetium bone scan with SPECT" not the answer?

Bone scintigraphy is non-specific and poorly sensitive for early sacroiliitis.

What concept does this question test?

It tests Musculoskeletal imaging: early sacroiliitis in Radiology. Radiographs show later changes such as erosions and sclerosis. Bone scans lack specificity and ultrasound cannot image the deep joint.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Musculoskeletal imaging: early sacroiliitis?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.