SAPHO综合征累及骨及关节99Tcm-MDP SPECT/CT显像表现

目的 观察⁹⁹Tc^m-MDP SPECT/CT显像所示滑膜炎、痤疮、脓疱病、骨肥厚及骨炎(SAPHO)综合征累及骨与关节表现。方法 回顾性分析69例SAPHO综合征患者⁹⁹Tc^m-MDP SPECT/CT资料,以聚类分析法评估SAPHO综合征累及骨、关节模式。结果 根据聚类分析,SAPHO所致骨与关节病变可分为肋骨型(n=19)、脊柱型(n=32)和胸锁关节型(n=18)。共于19例肋骨型检出145处病灶,包括60处肋骨病灶及95处其他病灶,半数以上呈低、中度摄取;半数呈溶骨性骨质破坏、边缘呈低度摄取;少数肋骨密度无明显改变。脊柱型多累及中轴骨 (27/32,84.38%);椎体病变多累及一侧肋椎关节、呈连续性分布及低、中度摄取。胸锁关节型均累及胸锁关节,半数以上病灶位于胸锁关节并呈高度摄取,以"牛头征"和"半牛头征" 为典型表现,多见骨质增生硬化、骨皮质肥厚。结论 SAPHO综合征累及骨关节可分为肋骨型、脊柱型及胸锁关节型。全身骨显像缺乏"牛头征"或"半牛头征"等典型表现时,结合临床表现及SPECT/CT融合显像有助于诊断。

99Tcm-MDP SPECT/CT observation on bone and joint involvement of SAPHO syndrome

Objective To observe bone and joint involvement of synovitis-acne-pustulosis-hypertrophy-osteitis (SAPHO) syndrome on ⁹⁹Tc^m-MDP SPECT/CT imaging. Methods Data of 69 cases with SAPHO syndrome were retrospectively analyzed. The mode of bone and joint involvement of SAPHO syndrome showed on ⁹⁹Tc^m-MDP SPECT/CT images observed and classified using Cluster analysis. Results Whole body bone and joint lesions could be classified as rib type (n=19), spine type (n=32) and sternoclavicular joint type (n=18) using cluster analysis. Totally 145 lesions were detected in 19 rib type cases, including 60 rib involvements (distributed in all 19 cases) and 95 other lesions. More than half rib lesions showed low to moderate uptake, half showed osteolytic bone destruction, while a few without obvious density changes. In 32 cases of spinal type, the axial bones were involved in 84.38% (27/32), and most spinal lesions involved one side of the costovertebral joint and showed continuous distributions, as well as low to moderate uptake. The sternoclavicular joint was involved in all 18 cases of sternoclavicular joint type, typically characterized by "bull head sign" or "half bull head sign", and more than half lesions located in sternoclavicular joint and showed moderate to high uptake, with hyperosteogeny and hypertrophy of bone cortex. Conclusion SAPHO syndrome involved bone and joint might be classified as rib type, spinal type and sternoclavicular joint type. When whole body imaging failed to detect typical characteristics like "bull head sign" or "half bull head sign", combining with clinical data and SPECT/CT findings were helpful for diagnosing SAPHO syndrome.