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Backgrounds  Whole-body bone scintigraphy (WBBS) and MRI are widely used in assessment of patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. However, the value of F-18 fluorodeoxyglucose-positron emission tomography/computed tomography ( 18 F-FDG PET/CT) in SAPHO syndrome was unclear. The aim of this study was to characterize the manifestation of SAPHO syndrome on  18 F-FDG PET/CT and explore its relationship with clinical symptoms and WBBS.    Methods  Twenty-six patients who suffered from SAPHO syndrome and had undergone whole-body  18 F-FDG PET/CT were recruited in Peking Union Medical College Hospital from 2004 to 2016. Clinical manifestations and laboratory findings were recorded for all patients. Imaging data on 18F-FDG PET/CT and WBBS were collected and analyzed retrospectively.    Results  All the 26 patients (20 females and 6 males) exhibited skeletal abnormalities on  18 F-FDG PET/CT. Multiple skeletal lesions affecting the anterior chest wall or spine with low to moderate  18 F-FDG uptake and coexistence of osteolysis and osteosclerosis presented as the typical features of SAPHO syndrome. Sixteen (61.5%) patients had abnormal  18 F-FDG uptake outside the osteoarticular system. PET scan had moderate to substantial agreement with CT and WBBS in revealing lesions in the anterior chest wall and axial skeleton. Nonetheless, the correlation between increased  18 F-FDG uptake and clinical symptoms was weak.    Conclusions  SAPHO syndrome exhibits characteristic features on  18 F-FDG PET/CT. It showed comparable capacity in revealing skeletal lesions with bone scintigraphy.    Electronic supplementary material  The online version of this article (10.1186/s13018-018-0795-0) contains supplementary material, which is available to authorized users.

F-18 FDG PET/CT in 26 patients with SAPHO syndrome: a new vision of clinical and bone scintigraphy correlation