痛风性关节炎的X线、CT和MRI诊断价值比较

Comparison of X-ray, CT and MR imaging in gouty arthritis

目的:比较X线、CT和MRI检查对痛风性关节炎的诊断价值。方法:回顾性分析56例痛风性关节炎患者共112个患病关节的X线、CT和MRI影像资料,采用卡方检验对比分析3种检查方法的检出率及对不同病变的显示率。结果:X线、CT、MRI检查的检出率分别为53%(59/112)、74%(83/112)、88%(99/112),MRI高于CT、X线(χ2=7.502,P=0.006;χ2=34.369,P<0.001)。X线显示痛风结节、关节面下囊变的关节个数少于MRI(χ2=24.605,P<0.001;χ2=31.112,P<0.001)和CT(χ2=18.576,P<0.001;χ2=13.069,P<0.001)。CT检查显示痛风结节和关节面下囊变的关节个数与MRI比较差异无统计学意义(χ2=0.466,P=0.495;χ2=3.211,P=0.073),但显示关节滑膜及韧带侵蚀、关节软骨侵蚀、关节积液和关节周围肌间隙水肿的关节个数均少于MRI(χ2=19.790,P<0.001;χ2=11.568,P<0.001;χ2=13.297,P<0.001;χ2=6.720,P=0.01)。结论 :X线、CT和MRI对痛风性关节炎均有较好的诊断能力,其中MRI检查总的检出率较高、发现病变的能力较好,CT检查则对痛风结节具有较高的特异性,而X线适用于中晚期患者的复查对照。

Objective： To compare the diagnosis value of X-ray, CT and MRI imaging in gouty arthritis. Methods： A ret- rospective study was performed in 112 symptomic joint of 56 patients with gouty arthritis. The images of X-ray, CT and MRI were collected. The Chi-square test was used to compare the diagnosis ability of X-ray, CT and MRI. Results： The diagnostic positive rate of X-ray, CT and MRI were 53%（59/112）, 74%（83/112） and 88%（99/112） respectively. MRI was superior to X- ray and CT（χ2=7.502, P=0.006; χ2=34.369, P〈0.001）. X-ray was inferior to CT（χ2=18.576, P〈0.001; χ2=13.069, P〈0.001） and MRI （χ2=24.605, P〈0.001; χ2=31.112, P〈0.001） in finding a tophus joint and cystic relevant section under the surface of the joints. There was no significant difference between CT and MRI in finding a tophus joint and cystic relevant section under the surface of the joints （χ2=0.466, P=-0.495; χ2=3.211, P=0.073）. However, MRI was superior to CT in finding synovial thick- ening and ligament erosion, cartilage erosion, joint effusion and muscle edema around the joint gap （χ2=19.790, P〈0.001; χ2= 11.568, P〈0.001; χ2=13.297, P〈0.001; χ2=6.720, P=0.01）. Conclusion： X-ray, CT and MRI all could be used for the diagno- sis of gouty arthritis. The diagnosis of MRI was superior to the others, but CT is characterized by specificity of tophus and X-ray could be employed in patients with comparison of severe lesion.