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Background: The understanding of non-radiographic axial spondyloarthritis (nr-axSpA) has accelerated over the last decade, producing a number of practice-changing developments. Diagnosis is challenging. No diagnostic criteria exist, no single finding is diagnostic, and other causes of back pain may act as confounders., Aim: To update and expand the 2014 consensus statement on the investigation and management of non-radiographic axial spondyloarthritis (nr-axSpA)., Methods: We created search questions based on our previous statements and four new topics then searched the MEDLINE and Cochrane databases. We assessed relevant publications by full-text review and rated their level of evidence using the GRADE system. We compiled a GRADE evidence summary then produced and voted on consensus statements., Results: We identified 5145 relevant publications, full-text reviewed 504, and included 176 in the evidence summary. We developed and voted on 22 consensus statements. All had high agreement. Diagnosis of nr-axSpA should be made by experienced clinicians, considering clinical features of spondyloarthritis, blood tests, and imaging. History and examination should also assess alternative causes of back pain and related conditions including non-specific back pain and fibromyalgia. Initial investigations should include CRP, HLA-B27, and AP pelvic radiography. Further imaging by T1 and STIR MRI of the sacroiliac joints is useful if radiography does not show definite changes. MRI provides moderate-to-high sensitivity and high specificity for nr-axSpA. Acute signs of sacroiliitis on MRI are not specific and have been observed in the absence of spondyloarthritis. Initial management should involve NSAIDs and a regular exercise program, while TNF and IL-17 inhibitors can be used for high disease activity unresponsive to these interventions. Goals of treatment include improving the frequent impairment of social and occupational function that occurs in nr-axSpA., Conclusions: We provide 22 evidence-based consensus statements to provide practical guidance in the assessment and management of nr-axSpA., (© 2021. The Author(s).)

Introduction: This study aims to determine the diagnostic accuracy of Primovist-enhanced MRI in the detection of hepatocellular carcinoma (HCC) in cirrhosis, using liver explant histopathology correlation., Methods: Thirty patients underwent a Primovist-enhanced MRI prior to liver transplantation for cirrhosis at the Princess Alexandra Hospital from 2006 to June 2012. Pre-contrast T1, T2 and post-Primovist arterial, portal venous and delayed hepatobiliary phase sequences were routinely obtained. A retrospective audit of MRI reports determined whether HCCs was identified on pre-transplantation imaging. Results were correlated to the explant liver histopathology. Specificity and sensitivity of Primovist in HCC identification in cirrhosis was determined., Results: The time interval between preoperative MRI and transplantation ranged from the day of transplantation to 112 weeks pre-transplantation. Thirty-nine HCCs were identified histologically in explants. Fifteen HCCs were identified on pre-transplant MRI in 11 patients, ranging from 11 to 43 mm, all confirmed on histopathology. Fourteen MRI studies identified no lesion, concordant on histology. Twenty-four either well or moderately differentiated HCCs were identified on histopathology, all of which were less than 17 mm, were not depicted on MRI. No poorly differentiated HCCs were present in the explants. Two regenerative nodules were correctly identified on MRI. This correlated to a sensitivity of 42.5%, specificity of 100% and a positive predictive value of 100% and negative predictive value of 39.5%., Conclusion: Primovist-enhanced MRI is very accurate in the identification of HCC in cirrhosis, especially if the tumour is greater than 17 mm and undifferentiated. However, sensitivity is reduced for well- and moderately differentiated HCC less than 17 mm., (© 2013 The Authors. Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists.)