Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic management of patients with SAPHO syndrome: use of MR imaging to guide bone biopsy at CT for microbiological and histological work-up

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1a–c.

Similar content being viewed by others

References

  1. Chamot AM, Benhamou CL, Kahn MF, Beraneck L, Kaplan G, Prost A (1987) Acne-pustulosis-hyperostosis-osteitis syndrome. Results of a national survey. 85 cases. Rev Rhum Mal Osteoartic 54:187–196

    CAS  PubMed  Google Scholar 

  2. Sonozaki H, Mitsui H, Miyanaga Y, Okitsu K, Igarashi M, Hayashi H, Matsuura M, Azuma K, Okai K, Kawashima M (1981) Clinical features of 53 cases with pustulotic arthroosteitis. Ann Rheum Dis 40:547–555

    CAS  PubMed  Google Scholar 

  3. Schilling F, Fassbender HG (1985) Sterno-kosto-klavikuläre Hyperostose-pustulotische Arthro-Osteitis-Pustulosis palmaris et plantaris: Eine enthesiopathische Extremform der psoriatischen Spondarthritis? Z Rheumatol 44:46

    Google Scholar 

  4. Dihlmann W, Dihlmann SW, Hering L (1997) Acquired hyperostosis syndrome–AHYS (sternocostoclavicular hyperostosis, pustulotic arthro-osteitis, SAPHO syndrome): bone scintigraphy of the anterior chest wall. Clin Rheumatol 16:13–24

    CAS  PubMed  Google Scholar 

  5. Kasperczyk A, Freyschmidt J (1994) Pustulotic arthroosteitis: spectrum of bone lesions with palmoplantar pustulosis. Radiology 191:207–211

    CAS  PubMed  Google Scholar 

  6. Dihlmann W, Dihlmann SW (1991) Acquired hyperostosis syndrome: spectrum of manifestation at the sternococtoclavicular region. Radiologic evaluation of 34 cases. Clin Rheumatol 10:250–263

    CAS  PubMed  Google Scholar 

  7. Kahn MF, Chamot AM (1992) SAPHO syndrome. Rheum Dis Clin North Am 18:225–246

    CAS  PubMed  Google Scholar 

  8. Bechtold RE, Karstaedt N, Wolfman NT (1990) MR appearance of sternal hyperostosis. J Comput Assist Tomogr 14:136–139

    CAS  PubMed  Google Scholar 

  9. Kahn MF, Bouvier M, Palazzo E, Tebib JG, Colson F (1991) Sternoclavicular pustulotic osteitis (SAPHO). 20-year interval between skin and bone lesions. J Rheumatol 18:1104–1108

    CAS  PubMed  Google Scholar 

  10. Boutin RD, Resnick D (1998) The SAPHO syndrome: an evolving concept for unifying several idiopathic disorders of bone and skin. Am J Roentgenol 170:585–591

    CAS  PubMed  Google Scholar 

  11. Reith JD, Bauer TW, Schils JP (1996) Osseous manifestations of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. Am J Surg Pathol 20:1368–1377

    Article  CAS  PubMed  Google Scholar 

  12. Benhamou CL, Chamot AM, Kahn MF (1988) Synovitis-acne-pustulosis hyperostosis-osteomyelitis syndrome (SAPHO). A new syndrome among the spondyloarthropathies? [see comments]. Clin Exp Rheumatol 6:109–112

    CAS  PubMed  Google Scholar 

  13. Edlund E, Johnsson U, Lidgren L, Petterson H, Sturfelt G, Svensson B, Theander J, Willen H (1988) Palmoplantar pustulosis and sternocostoclavicular arthro-osteitis. Ann Rheum Dis 47:809–815

    CAS  PubMed  Google Scholar 

  14. Kotilainen P, Merilahti Palo R, Lehtonen OP, Manner I, Helander I, Mottonen T, Rintala E (1996) Propionibacterium acnes isolated from sternal osteitis in a patient with SAPHO syndrome. J Rheumatol 23:1302–1304

    CAS  PubMed  Google Scholar 

  15. Gerster JC, Lagier R, Livio JJ (1990) Propionibacterium acnes in a spondylitis with palmoplantar pustulosis (letter to the editor). Ann Rheum Dis 49:337

    CAS  Google Scholar 

  16. Wagner AD, Mai U, Hammer M, Zeidler H (1997) Longterm antibiotic therapy successful in patients with SAPHO–syndrome. Arthritis Rheum 40:62

    PubMed  Google Scholar 

  17. Jurik AG, Egund N (1997) MRI in chronic recurrent multifocal osteomyelitis. Skeletal Radiol 26:230–238

    Article  CAS  PubMed  Google Scholar 

  18. Williamson MR, Quenzer RW, Rosenberg RD, Meholic AJ, Eisenberg B, Espinosa MC, Hartshorne MF (1991) Osteomyelitis: sensitivity of 0.064 T MRI, three-phase bone scanning and indium scanning with biopsy proof. Magn Reson Imaging 9:945–948

    CAS  PubMed  Google Scholar 

  19. Hopkins KL, Li KC, Bergman G (1995) Gadolinium-DTPA-enhanced magnetic resonance imaging of musculoskeletal infectious processes. Skeletal Radiol 24:325–330

    CAS  PubMed  Google Scholar 

  20. Trimble BS, Evers CJ, Ballaron SA, Young JM (1987) Intraarticular injection of Propionibacterium acnes causes an erosive arthritis in rats. Agents Actions 21:281–283

    CAS  PubMed  Google Scholar 

  21. Yocum RC, McArthur J, Petty BG, Diehl AM, Moench TR (1982) Septic arthritis caused by Propionibacterium acnes. J Am Med Assoc 248:1740–1741

    CAS  Google Scholar 

  22. Schilling F, Wagner AD (2000) Azithromycin: an anti-inflammatory effect in chronic recurrent multifocal osteomyelitis? A preliminary report. Z Rheumatol 59:352–353

    Article  CAS  Google Scholar 

  23. Freyschmidt J, Freyschmidt-Paul P (2001) SKIBO diseases: a concept to avoid bloody diagnostic procedures in ambiguous skeletal lesions. Eur Radiol 11:1729–1742

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The help of H. Steinlandt in editing and printing the illustrations, and the assistance of all colleagues in the departments of Radiology, Rheumatology, and Microbiology of Hannover Medical School are gratefully acknowledged.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany

    Timm Kirchhoff, Herbert Rosenthal, Mathias Prokop, Ajay Chavan & Michael Galanski

  2. Department of Rheumatology, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany

    Sonja Merkesdal, Annette Wagner & Henning Zeidler

  3. Institut fuer Med. Mikrobiologie und Hygiene, Haltenhoffstrasse 41, 30167, Hannover, Germany

    Uwe Mai

  4. Klinik fuer Rheumatologie, St. Josef-Stift, 48324, Sendenhorst, Germany

    Michael Hammer

Authors
  1. Timm Kirchhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sonja Merkesdal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Herbert Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mathias Prokop
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ajay Chavan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Annette Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Uwe Mai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael Hammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Henning Zeidler
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael Galanski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timm Kirchhoff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kirchhoff, T., Merkesdal, S., Rosenthal, H. et al. Diagnostic management of patients with SAPHO syndrome: use of MR imaging to guide bone biopsy at CT for microbiological and histological work-up. Eur Radiol 13, 2304–2308 (2003). https://doi.org/10.1007/s00330-003-1849-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-003-1849-0

Keywords

Search

Navigation