Hesse N, Hoppe B, Reidler P, Schmitt R
Klinik und Poliklinik für Radiologie, LMU München, Ziemssenstraße 5, 80336, München, Deutschland.
Department of Radiology, Haus A2/A3, Zentrum Operative Medizin, University Hospital of Wuerzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
Radiologie (Heidelb). 2025 Sep;65(9):681-687. doi: 10.1007/s00117-025-01487-1. Epub 2025 Jul 22.
CLINICAL/METHODOLOGICAL PROBLEM: SAPHO (synovitis, acne, pustulosis, hyperosteosis, osteitis) is a rare rheumatological disease characterized by combined osteoarticular and dermatological manifestations. Due to the nonspecific clinical presentation and skin findings, which may occur nonsimultaneously to the osteoarticular manifestations, diagnosis is usually delayed. Imaging plays a crucial role in identifying characteristic changes and distinguishing from differential diagnoses.
X‑ray diagnostics, computed tomography (CT), and skeletal scintigraphy are established procedures for detecting typical osseous changes such as hyperostosis, sclerosis, and osteitis. Magnetic resonance imaging (MRI) allows early detection of inflammatory bone and soft tissue changes.
METHODOLOGICAL INNOVATIONS/PERFORMANCE: Whole-body MRI is used for the systematic detection of multifocal lesions. Compared to scintigraphy, MRI offers the possibility of differentiating between active and inactive lesions without the use of ionizing radiation.
Whole-body MRI is an important addition to conventional methods, especially for the early and noninvasive assessment of active disease processes and is an integral part of diagnostic evaluation.
In cases where the differential diagnosis is unclear, histological evaluation of the bone lesions must be performed.
临床/方法学问题：滑膜炎、痤疮、脓疱病、骨肥厚、骨炎（SAPHO）综合征是一种罕见的风湿性疾病，其特征为骨关节和皮肤表现同时出现。由于临床表现和皮肤表现不具有特异性，且可能与骨关节表现不同时出现，因此诊断通常会延迟。影像学在识别特征性改变以及与鉴别诊断方面起着关键作用。
X线诊断、计算机断层扫描（CT）和骨闪烁扫描是用于检测诸如骨肥厚、骨质硬化和骨炎等典型骨质改变的既定检查方法。磁共振成像（MRI）能够早期检测出炎性骨和软组织改变。
方法学创新/性能：全身MRI用于系统性检测多灶性病变。与骨闪烁扫描相比，MRI无需使用电离辐射即可区分活动性和非活动性病变。
全身MRI是对传统方法的重要补充，尤其对于活动性疾病进程的早期和非侵入性评估而言，是诊断评估不可或缺的一部分。
在鉴别诊断不明确的情况下，必须对骨病变进行组织学评估。
