双能量能谱CT检测男性痛风患者足踝关节尿酸盐结晶沉积特点分析

Distribution of monosodium urate in male patients with gout in joint of foot and ankle by dual-energy gemstone spectral CT

目的 采用双能量能谱CT分析男性痛风患者足踝关节周围尿酸盐（MSU）沉积特点,评价MSU沉积与痛风性关节炎急性发作的相关解剖学和形态学特征。方法 对27例近期足踝部位痛风急性发作的男性痛风患者行双足踝关节双能量能谱扫描,采用χ~2检验分析MSU沉积的形态学特征及解剖学部位与相应区急性关节炎发作的关系。结果 27例患者均检测到MSU,分布于266处沉积区,最常出现MSU沉积的部位依次为软组织（66/266,24.81%）、第一跖趾关节（45/266,16.92%）、皮下（41/266,15.41%）、肌腱（27/266,10.15%）、距骨（26/266,9.77%）、胫骨下端（26/266,9.77%）、腓骨下端（18/266,6.77%）、跟骨（12/266,4.51%）、第一趾中远端（5/266,1.88%）。足关节中第一跖趾关节（χ^2=5.05,P〈0.05）有MSU沉积、呈点状分布（χ^2=8.02,P〈0.01）更易引起相应部位的急性关节炎发作。对于踝关节,无论MSU沉积的部位及形态均易引起相应部位关节炎的急性发作。足踝关节中多个MSU沉积亦易引起相应部位痛风性关节炎的急性发作。结论 双能量能谱CT可清晰显示MSU的沉积,MSU在足踝关节周围最易沉积于软组织及第一跖趾关节。MSU在足踝关节的沉积部位、形态及数目等对痛风性关节炎的急性发作有影响。

Objective To evaluate the features of monosodium urate （MSU） deposition in joint of foot and ankle with dual energy spectral CT, and to investigate the relationship between the features of the MSU and the attacks of join pain with foot and ankle. Methods Twenty-seven male patients were diagnosed as gout, who recently experienced foot and ankle swelling or pain were performed foot and ankle dual energy spectral CT. The relationship between the features of the MSU and the attacks of gouty arthritis was determined by Chi-square test. Results Two hundred sixty-six MSU depositions were found in 27 male gout patients, and the most common deposition site in turn were soft tissue （66/266, 24.81%）, the first metatarsophalangeal joint （45/266, 16.92%）, subcutaneous （41/266, 15.41%）, tendon （27/266, 10.15%）, the talus （26/266, 9.77%）, tibia lower （26/266, 9.77%）, fibula （18/266, 6.77%）, calcaneus （12/266, 4.51%）, the distal parts of the first toe （5/266, 1.88%）. Furthermore, patients with the MSU deposition in the first metatarsophalangeal joint （χ^2=5.05,P〈0.05） and punctate distribution （χ^2=8.02, P〈0.01） were more likely to cause corresponding parts of acute arthritis. About the ankle, whether MSU deposition location and deposition shape corresponding parts were prone to episodes of acute arthritis. In addition, multiple MSU deposition also affected episodes of acute attack of gout. Conclusion Dual-energy spectral CT can clearly show the deposition of MSU, MSU in the joints around the ankle are most likely deposited in the soft tissue and the first metatarsophalangeal joint. MSU deposition site, shape and number in the ankle joint can affect the acute attack of gouty arthritis.