SAPHO综合征患者骶髂关节病变的MRI表现

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。

Sacroiliac joint MRI findings in SAPHO syndrome

Objective: To retrospectively evaluate the MRI features of sacroiliac joint (SIJ) disorders in 13 SAPHO patients, thus increasing the awareness of SAPHO syndrome among clinicians and improving its diagnostic accuracy. Materials and Methods: 13 SAPHO patients with SIJ involvement (female: male, 9:4; mean±SD age, 45.9±8.9 years) who presented to Peking Union Medical College Hospital between November 2014 and August 2015 were enrolled. MR images of the SIJs were evaluated. Results: In our study, 11 SAPHO patients were involved with SIJ disorders bilaterally and 2 unilaterally. Therefore, a total of 24 SIJs were affected. Among the involved 24 SIJs, lesions in 16 SIJs predominantly affected the sacrum, and lesions in 20 SIJs involved both the synovial proportion and ligamentous proportion. Several abnormal MRI signal intensities in the bone adjacent to SIJs were detected, including bone marrow edema(16/24), fatty deposition(24/24), bony erosion(18/24) and sclerosis (19/24). Joint space widening was present in 8.3%(2/24) of SIJs, joint space narrowing in 16.7%(4/24) and articular ankylosis in 20.8%(5/24). Articular effusions were observed in 25%(6/24) of SIJs. Edema in the surrounding soft tissue was detected in 8.3%(2/24) of SIJs. Conclusion: SIJs were more bilaterally involved in SAPHO patients, with predilection on the sacrum. Active lesions and chronic lesions usually coexist, with a lower prevalence of ankylosing. These MRI features could provide certain information of SAPHO syndrome. Consultation of skin lesions should be taken into consideration for a comprehensive evaluation and definite diagnosis.