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Is the bullhead sign on bone scintigraphy really common in the patient with SAPHO syndrome? A single-center study of a 16-year experience.
Nucl Med Commun 2016; 37(4):387-92NM

Abstract

OBJECTIVE

The aim of this study was to assess the bone lesion distribution and analyze the frequency of the bullhead sign in patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome using whole-body bone scintigraphy (WBBS) in a relatively populous study population.

METHODS

In this study, the Nuclear Medicine Department's records of one center were retrospectively reviewed and the patients who fulfilled the diagnostic criteria for SAPHO syndrome and underwent Tc-99m-methylene diphosphonate WBBS were identified over a 16-year period. The following data were collected from patients, including age, sex, surgically proved pathology of the bone lesions, WBBS surveillance interval, and SAPHO syndrome components. The bone lesion distribution and the frequency of bullhead sign involving the manubrium and bilateral sternoclavicular junctions were analyzed.

RESULTS

Forty-eight patients were enrolled in this study. The initial WBBS indicated bone involvement in all of the 48 (100%) patients, in whom the most commonly affected region was the anterior chest wall (ACW) (100%, 48/48). The frequency of the upper costosternal junction involvement was the highest (38/48, 79.2%), and 28.9% (11/38) patients were found to show isolated involvement of the first rib in ACW. The frequency of the bullhead sign was only 22.9% (11/48, 95% CI: 12.0-37.3). In the eight (16.7%, 8/48) patients who were followed up using WBBS with an interval that ranged from 1 to 10 years, one patient with an initially single sternoclavicular junction lesion developed a typical bullhead sign over 10 years; other patients with or without the initial typical bullhead sign showed stable appearance over 1-4 years.

CONCLUSION

This retrospective study shows that in patients with proposed SAPHO syndrome, the bone lesions are most likely located in ACW, and the configuration of the bullhead sign is characteristic, but not entirely sensitive. The value of upper costosternal junction involvement, especially the first rib, may be underevaluated.

Authors+Show Affiliations

aDepartment of Nuclear Medicine, Peking University First Hospital, Beijing, China bDepartment of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26619395

Citation

Fu, Zhanli, et al. "Is the Bullhead Sign On Bone Scintigraphy Really Common in the Patient With SAPHO Syndrome? a Single-center Study of a 16-year Experience." Nuclear Medicine Communications, vol. 37, no. 4, 2016, pp. 387-92.
Fu Z, Liu M, Li Z, et al. Is the bullhead sign on bone scintigraphy really common in the patient with SAPHO syndrome? A single-center study of a 16-year experience. Nucl Med Commun. 2016;37(4):387-92.
Fu, Z., Liu, M., Li, Z., Fan, Y., Zhang, J., Zhang, X., & Li, Q. (2016). Is the bullhead sign on bone scintigraphy really common in the patient with SAPHO syndrome? A single-center study of a 16-year experience. Nuclear Medicine Communications, 37(4), pp. 387-92. doi:10.1097/MNM.0000000000000451.
Fu Z, et al. Is the Bullhead Sign On Bone Scintigraphy Really Common in the Patient With SAPHO Syndrome? a Single-center Study of a 16-year Experience. Nucl Med Commun. 2016;37(4):387-92. PubMed PMID: 26619395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is the bullhead sign on bone scintigraphy really common in the patient with SAPHO syndrome? A single-center study of a 16-year experience. AU - Fu,Zhanli, AU - Liu,Meng, AU - Li,Ziao, AU - Fan,Yan, AU - Zhang,Jianhua, AU - Zhang,Xuchu, AU - Li,Qian, PY - 2015/12/1/entrez PY - 2015/12/1/pubmed PY - 2016/12/15/medline SP - 387 EP - 92 JF - Nuclear medicine communications JO - Nucl Med Commun VL - 37 IS - 4 N2 - OBJECTIVE: The aim of this study was to assess the bone lesion distribution and analyze the frequency of the bullhead sign in patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome using whole-body bone scintigraphy (WBBS) in a relatively populous study population. METHODS: In this study, the Nuclear Medicine Department's records of one center were retrospectively reviewed and the patients who fulfilled the diagnostic criteria for SAPHO syndrome and underwent Tc-99m-methylene diphosphonate WBBS were identified over a 16-year period. The following data were collected from patients, including age, sex, surgically proved pathology of the bone lesions, WBBS surveillance interval, and SAPHO syndrome components. The bone lesion distribution and the frequency of bullhead sign involving the manubrium and bilateral sternoclavicular junctions were analyzed. RESULTS: Forty-eight patients were enrolled in this study. The initial WBBS indicated bone involvement in all of the 48 (100%) patients, in whom the most commonly affected region was the anterior chest wall (ACW) (100%, 48/48). The frequency of the upper costosternal junction involvement was the highest (38/48, 79.2%), and 28.9% (11/38) patients were found to show isolated involvement of the first rib in ACW. The frequency of the bullhead sign was only 22.9% (11/48, 95% CI: 12.0-37.3). In the eight (16.7%, 8/48) patients who were followed up using WBBS with an interval that ranged from 1 to 10 years, one patient with an initially single sternoclavicular junction lesion developed a typical bullhead sign over 10 years; other patients with or without the initial typical bullhead sign showed stable appearance over 1-4 years. CONCLUSION: This retrospective study shows that in patients with proposed SAPHO syndrome, the bone lesions are most likely located in ACW, and the configuration of the bullhead sign is characteristic, but not entirely sensitive. The value of upper costosternal junction involvement, especially the first rib, may be underevaluated. SN - 1473-5628 UR - https://www.unboundmedicine.com/medline/citation/26619395/Is_the_bullhead_sign_on_bone_scintigraphy_really_common_in_the_patient_with_SAPHO_syndrome_A_single_center_study_of_a_16_year_experience_ L2 - http://Insights.ovid.com/pubmed?pmid=26619395 DB - PRIME DP - Unbound Medicine ER -