Diagnostic management of patients with SAPHO syndrome: use of MR imaging to guide bone biopsy at CT for microbiological and histological work-up.
Propionibacterium acnes (P. acnes) is suspected to be involved in the pathophysiology of SAPHO syndrome, since it has been isolated repeatedly through open surgical bone biopsy. This study demonstrates the role of MRI in identifying inflamed bone areas in patients with SAPHO syndrome and the role of CT-guided bone biopsies in obtaining samples from these areas for microbiological and histopathological investigations, thus obviating open surgery. Fourteen consecutive patients with SAPHO syndrome were investigated by MRI to identify acute inflammatory changes in hyperostotic periarticular bone. The CT-guided biopsies for microbiological investigations were taken from the areas identified. Patients positive for P. acnes were started on long-term antibiotic therapy according to antibiotic susceptibility. On MRI the inflammatory changes appeared as hyperintense areas on fat-saturated T2 fast-spin-echo (FSE) images and showed signal increase on fat-saturated T1 SE images after Gd-DTPA. With MR localization CT-guided bone biopsies yielded P. acnes in 8 patients. No bacteria could be isolated from the remaining 6 patients. Acute inflammatory bone changes in SAPHO syndrome are well localized by MRI. With MR localization, CT-guided bone biopsies offer a minimally invasive alternative to open surgery in the detection of. P. acnes leading to the institution of a specific antibiotic therapy.
Kirchhoff
Timm
T
Department of Diagnostic Radiology, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany. kirchhoff.timm@mh-hannover.de
Merkesdal
Sonja
S
Rosenthal
Herbert
H
Prokop
Mathias
M
Chavan
Ajay
A
Wagner
Annette
A
Mai
Uwe
U
Hammer
Michael
M
Zeidler
Henning
H
Galanski
Michael
M
D020083:Acquired Hyperostosis Syndrome / Q000175:diagnosis*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016477:Artifacts; D001707:Biopsy, Needle / Q000379:methods*; D001853:Bone Marrow / Q000473:pathology*; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods
D000900:Anti-Bacterial Agents