痛风性关节炎的双能量CT影像学诊断

DECT Diagnosis of Gouty Arthritis

目的:分析痛风性关节炎(GA)的双能量CT(DECT)影像学表现,探讨痛风性关节炎DECT的诊断价值。方法:回顾性总结GA 188例DECT、48例X线、17例MRI影像学表现,比较DECT双能量分析对痛风结节的检出率,比较急性期、非急性期痛风受累关节的DECT影像学表现。结果:GA急性期有65例、非急性期有123例,男∶女为13.5∶1,平均年龄(55.2±15.2)岁。DECT双能量分析前后对急性期痛风结节检出率分别为16.92%、69.23%,对非急性期痛风结节检出率分别为20.32%、90.24%,差异均有显著性,P<0.05。GA急性期与非急性期比较痛风结节、关节囊及关节面病变检出率均有显著性差异,P<0.05。MRI检出GA急性期、非急性期关节软骨病变率分别为80%、66.7%。结论:DECT双能量分析可以特异性检出痛风结节,显著提高痛风结节的检出率。DECT能较好地检出痛风关节病变,非急性期痛风结节、关节囊、关节面病变率均高于急性期关节病变。MRI可以敏感地检出关节软骨病变。X线能检出非急性期痛风关节的改变。

Objective. To evaluate the application of Dual-Energy Computed Tomography （DECT） in the diag- nosis of gouty arthritis （GA）. Methods.. The data of 188 DECT, 48 X-Ray, and 17 magnetic resonance imaging （MRI） of GA were analyzed retrospectively. The evaluating indicators of imaging findings included soft tophi, bone erosion, hydrops articuli and cartilage lesion were evaluated by Dual-Energy gout software analysis. Results. There were 65 with acute GA and 123 with non-acute GA in 188 cases, including 175 males and 13 females, with an average age of （55.2± 15.2） years. The detection rate of tophi by Dual-Energy gout software analysis before vs after, was 16.92% vs 69.23% （P〈0.05） in acute GA patients and 20.32% vs 90.24% （P〈0.05） in non-acute GA patients. The detection rate of tophi, hydrops articuliby, and bone erosion in acute vs non-acute GA by DECT was 69.0% vs 90.3% （P 〈0.05）, 47.7% vs 66.7% （P〈0.05）, and 27.7% vs 47.2% （P〈0.05）. The detection rates of cartilage lesion between acute and non-acute GA by MRI were 80.0% （4/5） and 66.7% （8/12）. Conclusion： DECT has its unique strengths to detect monosodium urate （MSU）. The arthritic lesion rate in the non-acute GA is higher than in acute GA. MRI is found to be more sensitive in assessing cartilage lesion. Plain radiographs are less sensitive to early changes in chronic GA.