高频超声诊断痛风性关节炎第一跖趾关节病变

High-frequency ultrasound in diagnosis of gouty arthritis involving the first metatarsophalangeal joint

目的探讨高频超声(HFUS)诊断痛风性关节炎(GA)患者第一跖趾关节病变的价值。方法收集接受肌肉骨骼超声检查的GA患者(GA组)、无症状高尿酸血症(AH)患者(AH组)及健康志愿者(对照组)共334个第一跖趾关节,分别行背侧、内侧及底侧的长轴、短轴扫查,观察灰阶声像图及彩色多普勒血流显像情况。结果 GA组"双轨"征、非均匀回声结节的检出率高于AH组及对照组(P均<0.05);GA组点状强回声、骨皮质回声改变的检出率高于对照组(P均<0.05);AH组"双轨"征、点状强回声的检出率高于对照组(P均<0.05)。结论关节及其周围软组织出现"双轨"征、非均匀回声结节、点状强回声及典型骨皮质回声改变对GA具有诊断意义;HFUS可以作为诊断GA的非侵入性方法。

Objective To explore the value of high-frequency ultrasound （HFUS） in diagnosing gouty arthritis involving the first metatarsophalangeal joint. Methods A total of 334 first metatarsophalangeal joints of patients with GA （GA group）, asymptomatic hyperuricemia （AH group） or healthy people （control group） who underwent musculoskeletal HFUS examination were enrolled. The first metatarsophalangeal joints were examined in long and short axes from dorsal, medial and plantar aspects, respectively. The results of gray-scale ultrasound and color Doppler flow imaging were evaluated. Results The detection rate of ＂double contour＂ and heterogeneous echo nodule in GA group was higher than those in AH and control group （both P〈0.05）, of hyperechoic spot and the change of echo in bone cortical in GA group was higher than those in control group （both P〈0.05）, while of ＂double contour＂ and hyperechoic spot in the AH group was higher than those in control group （both P〈0. 05）. Conclusion The performances of ＂double contour＂, heterogeneous echo nodule, hyperechoic spot and the typical change of echo in bone cortical in surrounding soft tissue besides the first metatarsophalangeal joints have important value in diagnosis of GA. HFUS can be used as a noninvasive method in diagnosis of GA.