SAPHO综合征的全身骨显像及SPECT/CT影像分析

Whole-body bone scintigraphy and SPECT/CT imaging analysis of SAPHO syndrome

目的分析滑膜炎-痤疮-脓疱病-骨肥厚-骨炎(SAPHO)综合征全身骨显像和SPECT/CT的影像特点,探讨两种检查方法在SAPHO综合征中的诊断价值。方法回顾性分析2017年1月~2022年12月就诊于首都医科大学附属北京中医医院的41例SAPHO综合征患者的临床、全身骨显像及SPECT/CT断层显像资料。结果41例患者中,56%合并有皮肤损害,血红细胞沉降率、C反应蛋白、C3补体、C4补体升高的比例分别为63%、59%、17%、6%,14%的患者HLA-B27呈阳性。全身骨显像发现6例前胸壁受累、1例胸椎受累、1例胸腰椎及双侧骶髂关节受累,其余33例为多部位受累,依次为前胸壁(95%)、脊柱(58%)、骶髂关节(46%)、四肢关节(22%)、肋骨(12%)、耻骨(7%)、坐骨(5%)、股骨和颅骨(各2%)。19例行胸部和腰骶部SPECT/CT断层显像,前胸壁病灶主要位于胸锁关节和第一胸肋关节,“牛头征”是本病的特征性表现;脊柱病变多分布在胸腰椎,椎体前角骨质硬化较具特异性;骶髂关节多为双侧、髂骨面受累,多表现为骨质增生硬化。结论全身骨显像能够全面评估全身骨关节受累情况,SPECT/CT同时结合了骨断层显像的代谢信息及CT的解剖信息,二者联合在SAPHO综合征的早期诊断、精准定位和评估病情等方面具有重要价值。

Objective To analyze the imaging characteristics of whole-body bone scintigraphy and SPECT/CT in SAPHO syndrome and to investigate the diagnostic value of the two examination methods in SAPHO syndrome.Methods The clinical,whole-body bone scintigraphy,and SPECT/CT data of 41 patients with SAPHO syndrome admitted to Beijing Hospital of Traditional Chinese Medicine,Capital Medical University from January 2017 to December 2022 were retrospectively analyzed.Results Among the 41 patients,56%had a combination of skin lesions,and the proportions of patients with elevated ESR,CPR,C3 complement,and C4 complement were 63%,59%,17%,and 6%,respectively,while 14%were HLA-B27 positive.The whole-body bone scintigraphy showed that there were 6 cases of anterior chest wall involvement,1 case of thoracic vertebra involvement,1 case of thoracolumbar and bilateral sacroiliac joint involvement,and the remaining 33 cases of multisite involvement,in the order of the anterior chest wall(95%),spine(58%),sacroiliac joints(46%),joints of the limbs(22%),ribs(12%),pubis(7%),ischium(5%),femur and skull(2%each).Nineteen cases underwent SPECT/CT tomography of the chest and lumbosacral.The anterior chest wall lesions were mainly located in the sternoclavicular joints and the first sternocostal joints,and the“bullhead sign”was a characteristic manifestation of the disease.The spinal lesions were mostly distributed in the thoracolumbar spine,and the osteosclerosis of the anterior corners of the vertebral body was more specific.Sacroiliac joints were mostly involved bilaterally and on the surface of the ilium and mostly showed osteophytic sclerosis.Conclusion Wholebody bone scintigraphy can comprehensively evaluate the whole-body bone and joint involvement.SPECT/CT combines the metabolic information of bone tomography and the anatomical information of CT at the same time.The combination of the two is of great value in the early diagnosis,accurate localization,and disease assessment of SAPHO syndrome.