痛风性膝关节炎MRI骨侵蚀、骨髓水肿、滑膜炎与痛风石的相关性研究

目的探讨膝关节痛风性关节炎MRI特征,及骨侵蚀、骨髓水肿、滑膜炎与痛风石之间的相互关系,以研究痛风骨侵蚀和关节损伤的潜在机制。方法回顾性分析31例慢性痛风患者膝关节双能量CT和MRI影像检查,对比分析痛风石、骨髓水肿、骨侵蚀及滑膜炎之间的相关关系。结果4例患者为双侧膝关节检查,共35个膝关节纳入研究,其中34%的存在骨侵蚀,与痛风石有明显相关性,OR值76.4(95%CI 10.0,582.2)(P<0.001)。骨髓水肿不常见,发生率仅为1.2%(3/245),骨侵蚀和骨髓水肿之间没有明显相关性。在有骨侵蚀的膝关节中,75%的膝关节同时伴有滑膜炎,而在没有骨侵蚀的膝关节,43.4%的膝关节具有滑膜炎,骨侵蚀和滑膜炎之间的OR值为5.3(95%CI 1.1,25.5)(P=0.035)。结论痛风性关节炎骨侵蚀,与痛风石沉积明显相关;痛风骨髓水肿不常见,且水肿程度轻微。痛风石是骨侵蚀发生的主要危险因素之一。

Correlation study between MRI bone erosion,bone marrow edema,synovitis and tophi in gouty arthritis of the knee joint

Objective To explore the MRI characteristics of gouty arthritis of knee joint,and the relationship between bone erosion,bone marrow edema,synovitis and gouty stone,so as to study the potential mechanism of gout bone erosion and joint injury.Methods Dual-energy CT and MRI imaging of knee joint in 31 patients with chronic gout were retrospectively analyzed,and the correlation between gout stone,bone marrow edema,bone erosion and synovitis was compared.Results 4 patients underwent bilateral knee joint examination.A total of 35 cases of knee joint were included in the study.34%of them had bone erosion,which was significantly correlated with tophi,OR value of 76.4(95%CI 10.0,582.2)(P<0.001).However,Bone marrow edema was uncommonly and the incidence was only 1.2%(3/245),there was no significant correlation between bone erosion and bone marrow edema.75%knees with bone erosion were accompanied by synovitis,whereas 43.4%knees without bone erosion had synovitis,and the OR between bone erosion and synovitis was 5.3(95%CI 1.1,25.5)(P=0.035).Conclusion Bone erosion of gout arthritis was significantly related to tophi.The gout bone marrow edema is uncommon and the edema degree is slight.Tophi were the main risk factor for bone erosion.