MSUS和MRI诊断老年痛风性关节炎的临床价值分析

Clinical Value of MSUS and MRI in Diagnosis of Gouty Arthritis in Elderly Patients

目的比较肌肉骨骼超声(MSUS)和MRI对老年痛风性关节炎(GA)的临床诊断价值。方法回顾性分析河南省直第三人民医院2018年4月-2019年4月收治的33例老年GA患者MSUS和MRI检查图像及临床资料,比较MSUS和MRI检查阳性率,检出的关节腔积液、滑膜增生、周围组织炎症、骨侵蚀及痛风石等情况,分析二者对痛风典型症状的诊断敏感性和特异性。结果33例患者病理检查共检出病变部位67个,其中MSUS检查的阳性率为77.61%(52/67),MRI检查的阳性率为91.04%(61/64),MRI检查阳性率高于MSUS(P<0.05);67个病变部位的病变类型包括关节腔积液62个,滑膜增生67个,周围组织炎症48个,骨侵蚀17个,痛风石18个,MSUS与MRI检查对GA病变类型的诊断结果无明显差异(P>0.05);MSUS对痛风石的检出准确率、特异度高于MRI(P<0.05),两种检查方式的灵敏度和阳性预测值比较,差异无统计学意义(P>0.05)。结论MRI对GA病变部位的检查阳性率高于MSUS,对不同病变类型的诊断无差异,而MSUS对痛风石诊断的准确率、特异度高于MRI,可作为GA诊断的首选检查方法。

Objective To compare the clinical diagnostic value of musculoskeletal ultrasonography(MSUS)and MRI for gouty arthritis(GA)in elderly patients.Methods A retrospective analysis of MSUS and MRI images and clinical data of 33 elderly patients with GA who were admitted and treated in Henan Third People's Hospital between April 2018 and April 2019 was performed.The positive rates,joint effusion,synovial hyperplasia,inflammation of surrounding tissues,bone erosion and tophus detected by MSUS and MRI were compared.The diagnostic sensitivities and specificities of the two for typical gout symptoms were analyzed.Results A total of 67 lesions were detected by pathological examination in the 33 patients.The positive rate of MSUS[77.61%(52/67)]was lower than that of MRI[91.04%(61/64)](P<0.05).67 lesions included 62 joint effusions,67 synovial hyperplasia,48 surrounding tissue inflammation,17 bone erosion and 18 tophi.There was no significant difference between MSUS and MRI in diagnosis of types of GA lesions(P>0.05).The accuracy and specificity of MSUS in detection of tophus were higher than those of MRI(P<0.05),but there was no statistically significant difference in sensitivity or positive predictive value between the two examination methods(P>0.05).Conclusion The positive rate of MRI is higher than that of MSUS for GA,but there is no difference in diagnosis of different types of lesions.MSUS has higher accuracy and specificity than MRI in diagnosis of tophus.Therefore,it can be used as the first choice for diagnosis of GA.