痛风性关节炎:MRI表现及临床分析

MRI features and clinical analysis of gouty arthritis

目的：分析痛风性关节炎（GA ）的M RI表现及临床特点，提高诊断准确率。方法回顾性分析经临床及病理证实的15例GA的M RI及临床资料。结果15例临床均表现为程度不等的关节疼痛，11例同时伴有血清尿酸升高。15例中跖趾关节6例（5例发生于第1跖趾关节），踝关节4例，膝关节3例，肘关节及髋关节各1例，9例为2个以上关节受累。15例M RI均见受累关节软组织偏侧性肿胀及关节软骨程度不等的侵蚀，13例见关节面及邻近骨质不规则压迫、变薄或囊状、穿凿状破坏，并见邻近骨质及骨髓腔水肿、关节积液；11例显示结节状、条块状痛风结节，最大直径约3．5～56mm ，边界较清楚，位于关节滑膜、骨内或关节腔。痛风结节多数呈 T1 WI及 T2 WI较低信号，少部分呈 T1 WI较低T2 WI较高信号。12例伴有程度不等关节间隙狭窄、周边骨质增生硬化；5例出现关节明显畸形。结论 GA的影像学表现多样，M RI有利于显示痛风结节、早期的软组织病变及轻微软骨、骨质破坏，对其诊断具有重要价值。

Objective To analyse the MRI features and clinical characters of gouty arthritis and to improve the diagnostic accuracy .Methods The MRI data and clinical informations of 15 cases of gouty arthritis confirmed by clinic and pathology were reviewed .Results All 15 cases showed ache of joint of different degree ,11 cases accompanied with the hoist of uric acid .6 cases showed the injure of metatarsophalangeal joint ,of which 5 cases occured in the first metatarsophalangeal joint .4 cases occured in ankle and 3 cases in knee ,1 case in elbow and 1 case in hip ,and 9 cases showed multi-joint inju-ry .All 15 cases showed the anisomerous edema of soft tissue and different injury of cartilage .Irregular extrusion or de-struction of bone ,edema of bone and marrow and hydrocele of joint can be seen in 13 cases .Tophus with nodulated or nubbly shape can be seen in 11 cases located in the synovial bursa ,bone or articular cavity ,with clear border .The maxi-mum diameter was 3.5~56 mm .Most tophus were shown low signal on T1WI and T2WI ,and few focuses were shown T1 WI low signal and T2 WI high signal .12 cases accompanied with the straitness of joint and osteosclerosis ,obious abnor-mality of joint occured in 5 cases .Conclusion The imaging findings of gouty arthritis are various ,MRI can show tophus , the injury of soft tissue of early phase and the mild destruction bone or cartilage clear ,which is important for the diagnosis for gouty arthritis .