Prospective Comparison of the Imaging Value of 99mTc-MDP Bone Scan and 68Ga-FAPI-04 PET/CT in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome

Abstract

Purpose: This study aimed to explore the imaging value of 68 Ga-FAPI-04 PET/CT in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and compare it with that of 99m Tc-MDP bone scan. Methods: Nineteen participants with SAPHO syndrome underwent 68 Ga-FAPI-04 PET/CT and 99m Tc-MDP bone scan. Demographic data and clinical features were recorded, SAPHO imaging features were analyzed, and the osteoarticular lesion detection rate in both methods was calculated.Results: This prospective study recruited 4 men and 15 women aged 52.4 ± 8.6 years. The anterior chest wall was involved in all participants (100%). Palmoplantar pustulosis was the most common (36.8%) skin symptom. 99m Tc-MDP bone scan and 68 Ga-FAPI-04 PET/CT together detected 84 osteoarticular lesions, of which 91.7% (77/84) were detected by the former and 96.4% (81/84) by the latter. Furthermore, 68 Ga-FAPI-04 PET/CT detected 5 cases of knee and hip joint synovitis. Conclusions: 68 Ga-FAPI-04 PET/CT was more sensitive than 99m Tc-MDP bone scan when evaluating osteoarticular lesions in SAPHO syndrome and could also evaluate synovial lesions. 68 Ga-FAPI-04 PET/CT could be a good imaging method for SAPHO syndrome but requires further verification in a more extensive research cohort.

Application of Nuclear Medicine Techniques in Musculoskeletal Infection: Current Trends and Future Prospects

“…68Ga-FAPI showed greater sensitivity and accuracy than 18F-FDG in detecting disease, but the SUVmax of 68 Ga-FAPI could not differentiate between loosening and infection. Two recent studies explored 68Ga-FAPI-04 PET/CT in rheumatic diseases, specifically in SAPHO syndrome and rheumatoid arthritis [139,140], showing encouraging results in detecting synovitis and bone lesions, and there is an ongoing clinical trial in the diagnosis of spondyloarthritis (NCT05999643). Qin et al [141] investigated 68Ga-FAPI-04 using PET-MRI to differentiate between benign and malignant bone lesions.…”