获得性骨肥大综合征的影像表现

Imaging findings of synovitis-acne-pustulosis-hyperostosis-osteomylitis syndrome

目的 分析获得性骨肥大（SAPHO）综合征的影像表现.方法 回顾性分析11例SAPHO综合征的影像资料,男6例、女5例,年龄28～68岁,平均51岁,X线平片检查9例、CT检查10例、MR检查3例、核索扫描检查3例.结果 9例胸前壁X线平片表现为胸骨上部、第一前肋及锁骨增生、硬化并肥大,相互之间骨桥形成或骨性融合;10例胸前壁CT检查,9例表现为胸、肋、锁骨区骨质增生硬化伴有骨质破坏,胸锁关节和胸肋之间骨性融合,1例仅表现为胸骨柄体关节骨质硬化,2例在轴面像上胸骨柄上缘似＂海鸥翅＂样改变.11例患者中除1例胸骨病变仪累及胸骨柄体关节外,其余10例胸前壁均多骨受累,其中8例呈对称性,2例为偏侧性（均为右侧）.除胸前壁骨病变外,伴有骶髂关节炎、髂骨骨髓炎1例,胸椎骨髓炎2例,腰椎致密骨炎1例和双手掌指关节骨关节炎1例.MR检查3例,分别是胸锁关节、胸椎和骶髂关节,MRI显示锁骨头周围软组织肥厚,胸椎病变表现为椎体内T1WI呈低信号,T2WI呈混杂信号,抑脂像以高信号为主,骶髂关节见软骨下长T1WI短T2WI信号.核素扫描3例,显示胸骨上部及锁骨区呈＂T＂形异常高浓聚.结论 胸前壁多骨受累是SAPHO综合征主要影像特点,可并发骶髂关节炎、脊椎及髂骨骨髓炎、腰椎致密骨炎和双手骨关节炎.

Objective To explore the imaging characteristics of SAPHO syndrome in 11 cases.Methods Clinical features and imaging findings from 11 patients （6 male,5 female, 28 to 68 years old）with SAPHO syndrome were analyzed retrospectively Including DR in 9 cases, CT in 10 cases, MRI and radioisotope scanning in 3 cases. Results Multi-bones of anterior chest wall disorders were shown in 9cases on DR images including superior sternum , anterior first rib and clavicle hyperostosis. Bony fusion and bony bridge were also seen in these cases. Hyperostosis osteosclerosis, bone destruction and bony fusion of sternoclavicular articulation and first rib were shown on CT images in 9 cases. Osteosclerosis of the joint between manubrium and midsternum was seen in 1 case on CT image. Thc sign of flying sea gull was seen in 2 cases on axial anterior chest wall CT images. The disorders of anterior chest wall were bilateral in 8 cases and unilateral in 2 cases. Sacroiliitis and osteomyelitis of ilium were found accompanied in 1 case.Osteomyelitis of thoracic vertebrae were found in 2 cases, while sclerosing osteitis of lumbar vertebrae and ostearthritis of bilateral hands were observed respectively in 1 case. The thicken soft tissue surround clavicle head, thoracic vertebra disease with long T1 ,jumbly T2 and high fat suppression signal ,long T1 and short T2signal under sacroiliac joint were shown on MRI. Radioisotope scanning displayed higher radioactive uptake of radionuclides, with T shape in sternoclavicular area in 3 cases. Conclusions Multi-bones of anterior chest wall involvement was the common imaging characteristics in 11 patients. Sacroiliitis, osteomyelitis of vertebrae and ilium, sclerosing osteitis, ostearthritis of hand could be seen in some cases.