SAPHO Syndrome: Imaging Findings of Vertebral Involvement

Abstract

BACKGROUND AND PURPOSE:Imaging findings in patients with a combination of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) are often misinterpreted as discitis/osteomyelitis or metastases, resulting in multiple biopsies and delayed diagnosis. We have incidentally noted a semicircular morphology in vertebral body imaging in several cases of SAPHO syndrome with vertebral involvement. Our goal was to evaluate the prevalence of this distinctive morphology in these patients.

The European Society of Skeletal Radiology Quiz 2018

“…The term SAPHO is used to describe a combination of inflammatory osteoarticular (synovitis, hyperostosis, aseptic osteitis) and cutaneous manifestations (mainly palmoplantar pustulosis and acne) that can present at any age with a slight female predominance. [22][23][24][25] The pathogenesis remains elusive, and several hypotheses have been proposed including an infective cause, an association with seronegative spondyloarthropathies, and autoimmune dysfunction. Symptoms include pain, swelling, and decreased range of motion of the affected sites that commonly include the anterior chest wall and spine.…”

“…Symptoms include pain, swelling, and decreased range of motion of the affected sites that commonly include the anterior chest wall and spine. 23,24 Laboratory tests may reveal mildly raised inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein but otherwise are grossly unremarkable [22][23][24][25] ; 4 to 30% of patients are human leukocyte antigen B27 (HLA B27) positive. 23 One or more sites may be affected; whole-body MRI scan and bone scintigraphy may reveal occult sites of involvement.…”

“…23 The second most common site is the spine, particularly the thoracic, with vertebral body lesions that can appear curvilinear or semicircular, corner lesions and erosions, nonspecific spondylodiskitis, anterior longitudinal ligament thickening, sclerosis and paravertebral ossification. [22][23][24] Unilateral or asymmetric sacroiliitis can also be seen. 22,23 In children the clavicles and metaphysis of long bones are more commonly involved.…”

Reply:

“…W e thank Dr Colina for his comments regarding our recent article "SAPHO Syndrome: Imaging Findings of Vertebral Involvement." 1 We agree that growing awareness of SAPHO syndrome and its clinical and imaging findings will lead to earlier diagnosis.…”

Das SAPHO-Syndrom – ein Überblick

“…Bei entzündlichen Rückenschmerzen ist ein MRT zum Nachweis eines fokalen Knochenödems betroffener Wirbelkörper, einer Spondylodiszitis oder floriden Sakroiliitis geeignet. Im MRT lassen sich auch Weichteilveränderungen, wie ein verdicktes vorderes Längsband (80 % der Patienten) sowie entzündliche Proliferationen im paraspinalen Bindegewebe (37 %) nachweisen [17].…”