Bone scintigraphy using Tc-99m DPD and F18-FDG in a patient with SAPHO syndrome.
Synovitis (inflammatory arthritis), acne (pustulosa), palmoplantar pustulosis, hyperostosis and osteitis (bland osteomyelitis) are symptoms forming the acronym SAPHO. We present the case of a 48-year old man with sterno-costo-clavicular hyperostosis and typical pustulosis palmaris. We performed Tc-99m DPD serial bone scanning to monitor the course of disease and to assess therapeutic efficiency. Control bone scans in 2001 showed minor compromises of the ribs and diminished disease activity on collarbones and the sternum after medication with non-steroidal anti-inflammatory drugs (NSAIDs) and bisphosphonates. F-18 FDG PET presented synovial inflammation in the left sterno-clavicular joint but no relevant tracer uptake on clavicles or breastbones. In case of diagnostic doubts F-18 FDG PET could be recommended in order to discriminate bland osteomyelitis from bacterial osteomyelitis or from bone malignancy when SAPHO-syndrome is assumed.
Pichler
Robert
R
Department of Nuclear Medicine, General Hospital Linz, Linz, Austria. Robert.Pichler@akh.linz.at
Weiglein
Klaus
K
Schmekal
Barnhard
B
Sfetsos
Konstantinos
K
Maschek
Wilhelmine
W
D020083:Acquired Hyperostosis Syndrome / Q000000981:diagnostic imaging*; D000818:Animals; D001859:Bone Neoplasms / Q000000981:diagnostic imaging; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004164:Diphosphonates; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010019:Osteomyelitis / Q000000981:diagnostic imaging; D019275:Radiopharmaceuticals; D014055:Tomography, Emission-Computed
D004164:Diphosphonates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid; D019788:Fluorodeoxyglucose F18