SPECT/CT骨显像对SAPHO综合征的诊断价值

目的探讨SPECT/CT骨显像在滑膜炎、痤疮、脓疱病、骨肥厚、骨髓炎（SAPHO）综合征诊断中的临床价值。方法回顾性分析临床怀疑SAPHO综合征的11例患者的临床资料及SPECT/CT骨显像结果，所有患者均行99Tcm-MDP全身骨显像+局部断层显像及同机或异机CT扫描，获得SPECT全身骨显像和局部SPECT骨显像、CT显像、SPECT/CT融合显像图像。分析比较SPECT骨显像和SPECT/CT融合显像对SAPHO综合征诊断的准确率、灵敏度和特异度，组间准确率的比较采用χ2检验。结果11例临床怀疑SAPHO综合征患者中，9例经穿刺组织病理或随访病情最终转归而确诊，另外2例为转移瘤。其中，SPECT诊断6例，共发现41个病灶出现放射性浓聚；SPECT/CT诊断9例，共发现44个病灶。SPECT骨显像的灵敏度、特异度和准确率分别为66.7%（6/9）、50.0%（1/2）和63.6%（7/11）；SPECT/CT融合显像的灵敏度、特异度和准确率分别为100%（9/9）、50.0%（1/2）和90.9%（10/11），SPECT/CT融合显像对SAPHO综合症诊断的准确率明显高于单纯的SPECT显像，且差异具有统计学意义（χ2=11.82，P < 0.05）。结论SPECT/CT的联合应用提高了对病灶解剖定位的准确率及骨显像特异度，可用于SAPHO综合征患者的病灶精准定位、早期诊断与鉴别诊断、更多隐匿病灶检出以及病灶代谢活性评价等，对SAPHO综合征的诊断有较高的临床价值。

Value of SPECT/CT bone imaging in the diagnosis of SAPHO syndrome

ObjectivesTo discuss the clinical value of SPECT/CT bone imaging in the diagnosis of synovitis, acne, pustulosis, hyperostosis, and osteomyelitis (SAPHO) syndrome.MethodsThe clinical data and SPECT and SPECT/CT imaging results of 11 patients with suspected SAPHO syndrome were retrospectively analyzed. All patients underwent 99Tcm-MDP full-body bone imaging, local fault imaging, and CT scanning with the same or different machines. The accuracy, sensitivity, and specificity of the diagnosis of SAPHO syndrome through SPECT and SPECT/CT imaging were analyzed and compared. Data were analyzed through χ2 test.ResultsAmong 11 patients with suspected SAPHO syndrome, 9 underwent puncture pathology or follow-up for the definite diagnosis of their conditions. Two patients were diagnosed with metastatic tumors. In 6 patients with SPECT, 41 lesions exhibited radioactive concentration. Furthermore, 44 lesions were observed in 9 patients who were diagnosed through SPECT/CT. The sensitivity, specificity, and accuracy of SPECT and SPECT/CT imaging were 66.7%(6/9) and 100%(9/9), 50.0%(1/2) and 50.0%(1/2), 63.6%(7/11) and 90.9%(10/11), respectively. The diagnostic accuracy of SPECT/CT imaging for SAPHO syndrome was higher than that for pure SPECT. Moreover, the diagnostic accuracies of the two methods were significantly different(χ2=11.82, P < 0.05).ConclusionsThe combined application of SPECT/CT may improve the accuracy of identifying the anatomical orientations of lesions and the specificity of bone imaging. This method can be used for the precise localization of lesions, the identification and diagnosis of SAPHO in its early stages, the implicit detection of lesions, and the characterization of lesion metabolic activity. Therefore, the combined application of SPECT/CT diagnosis has high clinical value in the diagnosis of SAPHO syndrome.