SAPHO综合征多模态影像诊断中核素骨显像的重要价值

The important value of nuclear bone imaging in multimodal imaging diagnosis of SAPHO syndrome

目的:探讨SAPHO综合征的影像学表现及其诊断价值。方法:回顾性分析2018-2023年在本院确诊为SAPHO综合征的11例患者的临床表现、实验室检查结果及影像学资料。结果:11例中,男7例,女4例;年龄25~62岁,中位年龄39岁。所有患者有骨关节疼痛表现,最常见部位为前胸壁,其次为外周关节、腰背、臀区和足跟。7例出现皮肤病变,最常见表现为掌跖脓疱病(6例)。10例行SPECT全身骨扫描,10例均出现“牛头征”,其中3例合并外周骨关节放射性浓聚。8例行CT扫描,其中5例表现为胸锁关节和胸肋关节骨质增厚,2例表现为骶髂关节骨质增厚、硬化,1例表现为股骨骨皮质局限性增厚(12.5%)。7例行MRI扫描,3例表现为膝关节骨性关节炎和滑膜炎,其中2例还合并骶髂关节炎;另4例表现为椎间盘退变。1例行^(18)F-FDG PET-CT扫描,表现为两侧胸锁关节滑膜炎、关节面骨质破坏,FDG摄取无异常增高。结论:影像学检查对SAPHO综合征的诊断具有重要作用,尤其是SPECT骨显像对本病的诊断敏感性高,其显示的“牛头征”是诊断SAPHO综合征的特征性影像学表现。

Objective:The purpose of this study was to explorethe imaging features and diagnostic value of 11 patients with synovitis-acne-pustulosis-hyperostosis-osteomyeliti(SAPHO)syndrome.Methods:A retrospective analysis was performed for the symptoms,osteoarticular and skin signs,laboratory tests,and imaging findings of 11 patients diagnosedas SAPHO syndrome inour hospital from 2018 to 2023.Results:Among the 11 patients,7 were males and 4 were females,aged 25~62 years old with median age of 39.All the 11 patients had osteoarticular lesions,the most common part was the anterior chest wall,followed by peripheral joints,lower back,gluteal area,and heel.Skin lesions were present in 7 cases,the most common manifestation was skin signsare palmoplantar pustulosis(6 cases).Imaging manifestations include"bull's head sign"in all 10 cases of SPECT bone imaging,of which 3 cases were combined with peripheral bone and joint radioactivity concentration(30.0%).As of the 8 cases with CT scan,5 cases showed thickened of the sternoclavicular joints and thoracic rib joints,2 cases showed thickened sacroiliac joints with sclerosis,one case showed limited thickened femoral bone cortex.7 cases underwent MRI scan,of which 3 cases showed osteoarthritis and synovitis of the knee joint,including 2 cases also complicated with sacroiliac arthritis;and the other 4 cases showed degene-ration of the spine and intervertebral discs.One case underwent^(18)F-FDG PET-CT scan,and bilateral sternoclavicular synovitis and articular surface bone destruction with no abnormal increase in FDG uptake were the main findings.Conclusion:Imaging examinations play an important role in the diagnosis of SAPHO syndrome,especially SPECT radionuclide bone scan with high sensitivity.The"bull's head"sign is a characteristic imaging manifestation for the diagnosis of SAPHO syndrome.