MRI is now widely used to diagnose spondyloarthritis, but existing methods for image analysis rely on qualitative visual analysis by radiologists, and suffer from poor reproducibility between observers. Here, we show that proton density fat fraction (PDFF) measurements can be used as an objective, quantitative alternative to visual analysis. Using receiver operating characteristic (ROC) analysis, we find that PDFF measurements enable accurate separation of bone marrow edema (active inflammation) and fat metaplasia (structural damage) from normal marrow. The described approach is more objective than looking for 'a tiny bit of white' on fat-suppressed images, which is the current clinical standard.
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