双源CT诊断痛风性关节炎临床分析

Evaluation of dual-energy CT in patients with gout

目的采用非侵入性双源CT观察关节及周围组织的尿酸盐结晶，以探索临床诊断痛风或鉴别诊断其他关节疾病。方法选择近2周发作过单关节肿或（和）痛患者17例，均行病变关节双源CT检查。部分患者在B超下穿刺取关节液镜检。结果13例痛风患者发现33处有尿酸盐结晶，最常沉积的关节部位为双侧足趾关节（7／33）、近端指关节（5／33）、远端指间关节周围（4／33）、跖关节（4／33）、胫骨下端（3／33）。发现尿酸盐结晶易沉积在近关节骨表面，肌肉、韧带等关节周边软组织。关节肿痛部位与尿酸盐结晶沉积部位一致。尿酸盐结晶大小可以测量。结论双源CT可以清晰显示尿酸盐结晶，为无创检测手段。在鉴别诊断不明原因单关节肿痛方面有很好的价值。

Objective To explore the value of non-invasive dual-energy CT in the diagnosis of gout and the differential diagnosis of other joint diseases by observing urate crystals surrounding tissues. Methods Seventeen patients, who experienced unilateral arthrocele or joint pain in the past two weeks, were enrolled into our study. Dual-energy CT was performed in all patients and ultrasound-guided joint aspiration were performed in some patients. The location, quantity and size of urate crystals were analyzed by dual-energy CT. Results Thirty-three urate crystals were found in 13 gout patients, and the most common sites of deposition were bilateral inter-phalangeal joints of foot （7/33）, proximal inter-phalangeal joints （5/33）, tissues around distal interphalangeal joint （4/33）, metatarsal joints （4/33） and the lower part of the tibia （3/33）. The data indicated that urate crystals were more likely to deposit in the soft tissues around joints such as muscles, ligaments and so on, and the sites of deposition were consistent with the locations of arthralgia. The size of urate crystals could also be measured by dual-energy CT. Conclusion Urate crystals can be displayed by dual- energy CT. In addition, dual-energy CT is a non-invasive measure and it has great value in the differential diagnosis of joint diseases.