Skeletal Radiology

, Volume 44, Issue 1, pp 9–24 | Cite as

The SAPHO syndrome revisited with an emphasis on spinal manifestations

  • Antonio LeoneEmail author
  • Victor N. Cassar-Pullicino
  • Roberto Casale
  • Nicola Magarelli
  • Alessia Semprini
  • Cesare Colosimo
Review Article


The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome includes a group of chronic, relapsing, inflammatory musculoskeletal disorders with similar manifestations, in particular synovitis, hyperostosis, and osteitis, which may or may not be associated with neutrophilic skin eruptions such as palmoplantar pustulosis and acne conglobata. The syndrome occurs at any age, can involve any skeletal site, and its imaging appearances are variable, depending on the stage/age of the lesion and imaging method. The diagnosis is difficult if there is no skin disease. Awareness of the imaging appearances, especially in the spine, may help the radiologist in avoiding misdiagnosis (e.g., infection, tumor) and unnecessary invasive procedures, while facilitating early diagnosis and selection of an effective treatment. In this article, we provide an overview of the radiological appearances of SAPHO syndrome, focusing on the magnetic resonance imaging findings of vertebral involvement, and present relevant clinical and pathological features that assist early diagnosis.


SAPHO syndrome Spondyloarthropathy Synovitis Osteitis Hyperostosis 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© ISS 2014

Authors and Affiliations

  • Antonio Leone
    • 1
    Email author
  • Victor N. Cassar-Pullicino
    • 2
  • Roberto Casale
    • 1
  • Nicola Magarelli
    • 1
  • Alessia Semprini
    • 1
  • Cesare Colosimo
    • 1
  1. 1.Department of Radiological SciencesCatholic University, School of MedicineRomeItaly
  2. 2.Department of Diagnostic ImagingThe Robert Jones and Agnes Hunt Orthopaedic and District HospitalShropshireUK

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