SAPHO综合征患者骶髂关节病变的MRI表现

Sacroiliac joint MRI findings in SAPHO syndrome

目的回顾性分析13例SAPHO综合征患者的骶髂关节MRI图像,旨在提高临床医师对此病的认识,提高诊断的准确性。材料与方法纳入2014年11月至2015年8月于北京协和医院就诊的13例伴骶髂关节受累的SAPHO综合征患者,其中女9例,男4例,平均年龄(45.9±8.9)岁,总结其骶髂关节病变的影像学特征。结果 13例患者中双侧骶髂关节受累者有11例,单侧者2例,因此,共24个骶髂关节受累。16个关节以骶骨侧病变为主,20个关节病变同时累及滑膜部和韧带部。一些骶髂关节邻近骨质出现异常MRI信号,包括骨髓水肿信号(16/24)、脂肪沉积信号(24/24)、骨质破坏(18/24)、骨质硬化(19/24)。关节间隙增宽者占8.3%(2/24),关节间隙狭窄者占16.7%(4/24),关节强直者占20.8%(5/24)。25%(6/24)的病变关节出现关节腔积液,8.3%(2/24)的病变关节出现周边软组织水肿。结论 SAPHO综合征患者的骶髂关节病变多为双侧受累、骶骨侧病变为主,且具有新老病灶并存的特点,较少引起关节强直。上述特征可从影像学上提示SAPHO综合征,结合患者的皮肤病变,综合评估做出诊断。

Objective:To retrospectively evaluate the MRI features of sacroiliacjoint(SIJ)disorders in13SAPHO patients,thus increasing the awareness of SAPHOsyndrome among clinicians and improving its diagnostic accuracy.Materials andMethods:13SAPHO patients with S J involvement(female:male,9:4;mean士SDage,45.9士8.9years)who presented to Peking Union Medical College Hospitalbetween November2014and August2015were enrolled.MR images of the SIJs wereevaluated.Results:In our study,11SAPHO patients were involved with SIJ disordersbilaterally and2unilaterally.Therefore,a total of24SIJs were affected.Among theinvolved24SIJs,lesions in16SIJs predominantly affected the sacrum,and lesionsin20SIJs involved both the synovial proportion and ligamentous proportion.Severalabnormal MRI signal intensities in the bone adjacent to SIJs were detected,includingbone marrow edema(16/24),fatty deposition(24/24),bony erosion(18/24)andsclerosis(19/24).Joint space widening was present in8.3%(2/24)of SIJs,joint spacenarrowing in16.7%(4/24)and articular ankylosis in20.8%(5/24).Articular effusionswere observed in25%(6/24)of SIJs.Edema in the surrounding soft tissue wasdetected in8.3%(2/24)of SIJs.Conclusion:SIJs were more bilaterally involved inSAPHO patients,with predilection on the sacrum.Active lesions and chronic lesionsusually coexist,with a lower prevalence of ankylosing.These MRI features couldprovide certain information of SAPHO syndrome.Consultation of skin lesions shouldbe taken into consideration for a comprehensive evaluation and definite diagnosis.