膝关节痛风性关节炎的MRI诊断

MR Diagnosis of Gouty Arthritis in the Knee

目的探讨膝关节痛风性关节炎的MRI特征性表现。资料与方法回顾性分析7例经手术、病理证实为膝关节痛风性关节炎的MRI表现。所有病例均做SE序列T1WI和FSE序列T2WI。其中4例做了钆喷酸葡胺(Gd-DTPA)增强扫描。结果膝关节骨质侵蚀破坏5例,股骨髁4例,髌骨下缘1例;股骨髁间窝区域、髌下脂肪区和/或髌韧带周围软组织见团块状病灶6例。全部痛风石病灶T1WI均呈低至中等信号;T2WI有2例呈低信号,3例有低信号病灶和低至稍高混杂信号病灶,另2例则为高信号。4例增强后,病灶无强化1例,轻度不均匀强化1例,病灶边缘强化2例。结论膝关节痛风性关节炎的MRI特征性表现常是T1WI和T2WI均呈低至中等信号的肿块状病灶,且具边缘强化,其对膝关节痛风性关节炎的诊断很有价值。

Objective To discuss MRI characteristic features of gouty arthritis in the knee. Materials and Methods MRI findings of 7 patients with surgical and pathological proved gouty arthritis of the knee were retrospectively reviewed. All patients underwent knee MRI plain scan with SE TIWI and FSE T2WI sequence. SE sequence T1 WI was obtained after IV admintration of Gd-DTPA in 4 patients. Results 5 patients had bone erosion in the knee,4 patients in the femoral condyles, 1 patient in the patella, 6 patients had the soft tissue masses in the intercondylar notch and in the subpatellar fat area or/and around the patellar ligament. All the gouty tophi demonstrated hypointensity to isointensity signal on T1WI. The gouty tophi in 2 patients demonstrated hypointensity signal on T2 WI, the gouty tophi in 3 patients demonstrated hypointensity or heterogeneous hypointensity to slightly hyperintensity signal on T2 WI and in 2 patients demonstrated hyperintensity signal on T2 WI. After contrast administration in 4 patients, the gouty tophi in 1 patient demonstrated no enhancement, the gouty tophi in 1 patient with slightly heterogeneous enhancement and in 2 patients with peripheral enhancement. Conclusion MRI characteristic features of gouty arthritis of the knee often present as masses of hypo to isointensity on both T1WI and T2WI with peripheral enhancement, which are helpful in the diagosis of gout arthritis of the knee.