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SIJ - differentials
OCI / postpartum changes
Strain-related SIJ changes
Degenerative / DISH changes
Infectious sacroiliitis
Inflammatory conditions
Metabolic disorders
Spine - differentials
Degenerative changes
Infectious spondylitis
Other strain-related SIJ changes

Other strain-related SIJ changes will usually occur in the load-related areas of the joint at the superior/middle anterior portion where subchondral BME, sclerosis and/or fat metaplasia in addition to erosion-like irregularities may occur (doi:10.1186/s13075-022-02760-7).

BME has been reported relatively frequent in patients with mechanical back pain and also in healthy, especially sports active persons, but the BME observed is usually minimal compared to BME in axSpA and deep BME lesions are rarely seen (doi:10.1002/art.40475). The use of STIR sequences in two planes facilitate the exact location of BME and minimize mis-interpretation of changes due to partial volume effect (doi:10.1093/RHEUMATOLOGY/KEZ458).

MRI of the SIJ and the lumbar spine in a patient with L5/S1 disk degeneration (open arrow) and strain related changes at the right SIJ in the form of BME confined to the anterior middle portion of the sacrum (arrows). The depth of the BME is >1cm, but the intensity is less than typical of axSpA lesions which also is seen on the T1-weighted image in the form of persistence of fat signal in the BME area. There are no SIJ erosions.

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