高频超声特征性表现在痛风性关节炎 病变早期诊断价值

目的探讨高频超声特征性表现在痛风性关节炎病变早期诊断中的价值。方法选取自2017年1月至2018年11月北部战区总医院收治的32例痛风性关节炎患者为B组,另选取同期在我院就诊的临床确诊为类风湿性关节炎或骨性关节炎的28例患者作为A组。两组患者均进行超声检查,记录并比较患者的全部受累关节的关节腔积液、滑膜增生、骨侵蚀及关节周围的尿酸盐沉积、双轨征、痛风石的检出率。结果两组患者关节腔积液、滑膜增生及骨侵蚀的检出率比较,差异无统计学意义(P>0.05)。B组双轨征、尿酸盐沉积、痛风石的检出率均高于A组,组间比较,差异均有统计学意义(P<0.05)。结论双轨征、尿酸盐沉积、痛风石为痛风性关节炎超声特征性表现,高频超声检查对痛风性关节炎具有较高诊断价值。     

肌肉骨骼超声检查在痛风性关节炎患者中的应用价值

目的探讨超声检查在临床诊断痛风性关节炎患者中的价值。方法选取于医院治疗的100例痛风性关节炎患者作为观察组,另选取50例类风湿关节炎、骨关节炎及强直性脊柱炎患者作为对照组。采用对观察对象进行超声检查,记录超声检查表现及诊断价值。结果 100例痛风性关节炎患者中,共检查600个关节,对照组50例患者(300个关节),两组超声表现出双轨征、结晶聚集、关节腔积液、滑膜增生及骨侵蚀存在明显差异,P0.05。观察组可见双轨征或结晶聚集者为74例,诊断敏感性为74.0%,阳性预测值为88.09%(74/84)。对照组可见双轨征或结晶聚集者为6例,诊断特异性为88.0%(44/50),阳性预测值为70.97%(44/62)。结论应用超声对诊断痛风性关节炎具有一定价值,有利于临床医生鉴别和诊断痛风与其他关节炎。     

高频超声在高尿酸血症患者早期关节病变筛查中的应用

尿酸盐(MSU)沉积是判定无症状性高尿酸血症(AH)进展为痛风性关节炎的金标准。如何无创性诊断关节及周围组织中存在的MSU沉积,在AH患者中筛查出早期关节病变患者,并为开始规范降尿酸治疗选择合适的时机,成为热门的研究方向。高频超声可清晰显示骨与关节周围的软组织结构,且对早期MSU沉积组织有特异性表现,相对其他影像学技术,对筛查AH早期关节病变有一定优势,现予以综述。     

痛风结节超声显像与X线检查对照分析

痛风是由于嘌呤代谢紊乱使血液中尿酸浓度增高所致的一组症候群[1].为尿酸盐结晶沉积导致关节及软组织的损害,当关节及周围软组织受累时,则引起关节旁或关节内尿酸盐结晶沉积而形成痛风性关节炎症的.反复发作则造成关节畸形[2].为探讨本病的声像特征,我们对2008年1月～2010年8月经临床、实验室检查证实的痛风性结节31例患者进行超声检查,并与X线诊断作对照,旨在探讨高频超声在痛风性结节诊断中的价值.     

痛风性关节炎的CT、MRI对照分析

目的比较CT、MRI影像检查在痛风性关节炎中的诊断价值。方法选取我院2017年4月~2020年4月收治的经临床证实为痛风性关节炎患者80例作为观察对象,对所有患者实施CT及MRI检查,观察两种检查方法的诊断结果及影像学表现。结果80例患者确诊病变关节194个。CT检查共检出病变关节146个,MRI共检出病变关节186个,CT检查灵敏度(146/194)低于MRI(173/194)(P<0.05);相比于CT,MRI在关节积液、痛风结节、滑膜增厚、骨质破坏、关节周围水肿的检出率都更高。结论MRI对痛风性关节炎的诊断效果良好,可对关节炎病变进行较为准确的观察,具有临床推广价值。     

肌骨超声在痛风诊疗中的应用与研究进展

痛风是由长期高尿酸血症（HUA）导致单钠尿酸盐（MSU）晶体在关节和其他组织中异常沉积所引起的代谢性疾病。超声可早期发现MSU晶体在关节周围沉积,从无症状高尿酸血症（AH）期到痛风晚期均有特异性超声表现,而且超声可对痛风累及范围和程度进行随访监测。综述痛风的超声影像学特点并对超声在降尿酸治疗监测和痛风治疗中的研究进展加以介绍。     

痛风性关节炎的影像学研究进展

痛风是体内嘌呤代谢紊乱,血尿酸增多所致的一种代谢性风湿病。高尿酸血症导致尿酸盐结晶沉积于关节内及关节外组织,从而形成痛风性关节炎。痛风流行于世界各地,我国痛风的患病率约为0.34%~2.84%,呈升高趋势[1],其防治任务更加艰巨,早诊断、早治疗对痛风患者至关重要。目前痛风诊断多采用1977年美国风湿病学会(American college of rheumatology,ACR)制订的痛风分类标准,即:①关节液中有特异度尿酸盐结晶,或②用化学方法或偏振光显微镜证实痛风石中含尿酸盐结晶,或③具备以下12项(临床、实验室、X线表现)中6项,A.急性关节炎发作>1次;B.炎症反应在1 d内达到高峰。     

双能量CT评估慢性痛风性关节炎尿酸盐结晶的相关因素研究

目的双能量CT测定慢性痛风性关节炎患者尿酸盐结晶情况,探讨双能量CT测定尿酸盐结晶对慢性痛风性关节炎的诊断价值及尿酸盐结晶的影响因素。方法选择2014年1月～2015年12月慢性痛风性关节炎患者90例作为痛风组和非痛风性关节炎患者90例作为非痛风组,并根据血尿酸水平分为正常尿酸组和高尿酸组,双能量CT扫描患者尿酸盐结晶情况。结果高尿酸组双能量CT检测尿酸盐结晶阳性率高于正常尿酸组(P0.05)。痛风组90例患者中,双能量CT测定尿酸盐结晶诊断痛风(尿酸盐结晶阳性)81例,非痛风9例;非痛风组90例患者中,双能量CT诊断痛风24例,非痛风56例。双能量CT对痛风性关节炎的诊断灵敏度、特异度分别为89.0%、89.9%,阳性预测值和阴性预测值分别为90.0%、88.9%,Youden指数和诊断符合率分别为78.9%、89.4%。单因素分析:尿酸盐结晶组男性所占比例高于无尿酸盐结晶组(P0.05),尿酸盐结晶组病程和血尿酸水平高于无尿酸盐结晶组(P0.05)。logistic回归多因素分析:血尿酸水平影响尿酸盐结晶沉积(P0.05)。结论双能量CT通过评估尿酸盐结晶情况对慢性痛风性关节炎有良好的诊断价值,血尿酸水平是尿酸盐结晶的独立影响因素。     

双能量CT对痛风性关节炎的诊断价值

目的 探讨双能量CT(DECT)对痛风性关节炎的诊断价值.方法 对52例患者行关节DECT扫描,病例组为21例痛风患者,对照组为非痛风患者31例,根据扫描部位有无金属内固定将对照组分为2组,6例有内固定为对照1组,25例无内固定为对照2组.扫描部位包括双侧足、踝关节、膝关节、手或腕关节,利用痛风结石软件进行分析,并以绿色伪彩显示,记录是否能够显示痛风石以及其分布情况,统计尿酸盐结晶沉积病灶数.对患者检查部位进行临床体检,统计临床病灶数目及部位.同时检测所有患者的血尿酸、血肌酐、总胆固醇及甘油三酯水平.对比病例组与对照组的DECT检查结果及临床体检之间的差异.统计学处理采用t检验和卡方检验.结果 ①病例组21例患者均显示多发痛风石,以趾(指)间关节、楔骨间关节及其周围软组织最显著;对照1组6例患者有内固定一侧均有绿色标记显示,对侧关节均未见显示;对照2组25例患者,除1例显示少许绿色标记外,其余均未见绿色显示,与病例组差异有统计学意义(P=0.000).DECT诊断痛风性关节炎的敏感性、特异性、准确性分别为100％ (21/21)、77.4％(24/31)、86.5％ (45/52).②21例痛风患者尿酸盐沉积DECT共发现237处,是临床估计病变部位的2.58倍(临床估计病灶共92处),差异有统计学意义(P=0.000).③病例组患者血尿酸、血肌酐、甘油三酯及总胆固醇水平较对照组明显增高,差异有统计学意义(P=0.000,0.002,0.021,0.039).结论 DECT能以伪彩色编码的形式清晰显示痛风患者尿酸盐沉积,包括一些亚临床痛风,对痛风性关节炎的诊断有潜在的临床价值.     

痛风性关节炎患者第一跖趾关节尿酸盐负荷的评估及预测

目的 基于2021年风湿病临床试验预后评价痛风工作组的超声半定量评分系统（SQUS）对痛风患者第一跖趾关节（MTP1）评分（SQUS-MTP1），以评估尿酸盐负荷，并分析尿酸盐负荷的影响因素和尿酸盐沉积的独立危险因素。资料与方法 前瞻性研究2020年9月—2021年11月于川北医学院附属医院确诊的192例痛风性关节炎患者，超声检查双下肢关节的特征性痛风征象，评估双侧MTP1尿酸盐负荷，分析尿酸盐负荷的影响因素及尿酸盐沉积的独立危险因素。结果 痛风病程、年龄、血清尿酸（SUA）与MTP1尿酸盐负荷的多元线性回归分析差异均有统计学意义，建立回归模型MTP1尿酸盐负荷=13.29+0.18×病程+0.05×年龄+0.03×SUA。SUA(OR=1.010)与SQUS-MTP1分组的二元Logistic回归分析差异有统计学意义。结论 联合痛风病程、年龄、SUA能初步预测痛风性关节炎患者MTP1尿酸盐负荷；SUA升高是痛风性关节炎患者MTP1尿酸盐沉积的独立危险因素。     

痛风性关节炎的超声研究进展

痛风性关节炎是临床常见疾病，由单钠尿酸盐结晶沉积在软骨、关节和周围软组织引发。超声不仅能用于痛风性关节炎的诊断和疗效评估，还可以引导细针穿刺获得诊断所需的组织样本。介绍痛风性关节炎的实用超声检查方法（六分钟检查法），以及超声在痛风性关节炎不同时期（无症状高尿酸血症期、急性期、发作间期和慢性期）中的诊断应用。在痛风性关节炎的诊治上，超声比X线、CT和MRI更有效，而且无辐射、检查费用低。     

Diagnostic efficacy of joint ultrasonography,dual-energy computed tomography and minimally invasive arthroscopy on knee gouty arthritis,a comparative study

Objective:This study aimed to investigate the diagnostic performance of minimally invasive arthroscopy for knee gout when comparing with joint ultrasonography and dual-energy computed tomography (DECT).Methods:From January 2016 to December 2018, 121 inpatients with knee joint swelling and pain were prospectively enrolled, including 63 gout patients and 58 non-gout patients. All patients underwent pre-operative ultrasonography and DECT to evaluate knee joint monosodium urate (MSU) deposits, followed by minimally invasive arthroscopy. The gold-standard for gout diagnosis was defined as the detection of MSU crystals in the synovial fluid under polarizing microscopic or pathological analysis.Results:The diagnostic results of ultrasonic double contour sign, hyperechogenic foci, MSU deposition (detected by DECT), MSU deposition (detected by arthroscopy) and MSU deposition in cartilage (detected by arthroscopy) were significantly associated with that of the gold-standard. Except for hyperechogenic foci, the other four indexes had high sensitivity and specificity (approximately or over 80%) and a large odds ratio (OR) (14.73 to 36.56), indicating good diagnostic performance. Detection of MSU deposition in cartilage by arthroscopy had a good diagnostic agreement with the ultrasonic double contour sign (κ = 0.711, p < 0.001).Conclusion:Joint ultrasonography, DECT, and minimally invasive arthroscopy had high sensitivity and specificity for the diagnosis of knee gouty arthritis. Minimally invasive arthroscopy was superior to joint ultrasonography and DECT, which can be a useful supplement for the diagnosis of gout.Advances in knowledge:This is the first study comparing the diagnostic performance for knee gout among the joint ultrasonography, DECT, and minimally invasive arthroscopy.     

Gout of hand and wrist: the value of US as compared with DECT

Objectives

The purpose of this study was to compare findings of ultrasound (US) with dual-energy CT (DECT) in patients presenting with suspected gouty hand and wrist arthritis.

Methods

This prospective study included 180 patients (136 men and 44 women, age range, 31– 94 years; mean age, 65.9 years) with an initial clinical diagnosis of acute gouty arthritis who underwent DECT and US examination. Intra- and extra-articular findings of each modality were tabulated and calculated with DECT as gold standard.

Results

The final diagnosis of gout was positive in 97/180 patients (53.9%) by DECT, an alternative diagnosis confirmed in 83 patients. US showed a sensitivity of 70.1% (extra-articular: 42.5%, p < 0.0001; intra-articular: 80.3%, p = 0.14) and specificity of 51%. The double contour sign (DCS) was present in 58/61 patients with a positive US study for intra-articular gout (95.1%).

Conclusions

Sensitivity of US for diagnosis of gouty arthritis in hand and wrist is limited, particularly with respect to extra-articular urate deposition. The DCS is the most sensitive sign for the assessment of gouty hand and wrist arthritis by US.

Key points

? Sensitivity of US for diagnosis of gouty arthritis in hand and wrist is limited, particularly with respect to extra-articular gouty deposits. ? The double contour sign is the most sensitive finding for the assessment of gouty hand and wrist arthritis by US. ? Although the sensitivity of US for diagnosis of gouty hand and wrist arthritis is limited, it can be used as a first-line imaging modality in the presence of the DCS.

     

痛风性关节炎：MRI表现及临床分析

目的：分析痛风性关节炎（GA ）的M RI表现及临床特点,提高诊断准确率。方法回顾性分析经临床及病理证实的15例GA的M RI及临床资料。结果15例临床均表现为程度不等的关节疼痛,11例同时伴有血清尿酸升高。15例中跖趾关节6例（5例发生于第1跖趾关节）,踝关节4例,膝关节3例,肘关节及髋关节各1例,9例为2个以上关节受累。15例M RI均见受累关节软组织偏侧性肿胀及关节软骨程度不等的侵蚀,13例见关节面及邻近骨质不规则压迫、变薄或囊状、穿凿状破坏,并见邻近骨质及骨髓腔水肿、关节积液;11例显示结节状、条块状痛风结节,最大直径约3．5～56mm ,边界较清楚,位于关节滑膜、骨内或关节腔。痛风结节多数呈 T1 WI及 T2 WI较低信号,少部分呈 T1 WI较低T2 WI较高信号。12例伴有程度不等关节间隙狭窄、周边骨质增生硬化;5例出现关节明显畸形。结论 GA的影像学表现多样,M RI有利于显示痛风结节、早期的软组织病变及轻微软骨、骨质破坏,对其诊断具有重要价值。     

Gouty arthritis: A prospective radiographic evaluation of sixty patients

A prospective analysis of 60 patients with gout was undertaken to evaluate the radiographic spectrum of gouty arthritis in patients treated in the era of hypouricemic therapy. Twenty-two of these patients were clinically tophaceous; 36 were considered to have radiographic findings diagnostic of gouty arthritis by strict radiographic criteria. Up to 24% of the patients denied symptoms in joints with radiographic changes of gout; 42% with no evidence of tophi on clinical examination had radiographic changes characteristic of gout. Radiographic assessment can be extremely helpful in the management of gout by documenting the degree and extent of bony involvement, particularly in patients with limited symptoms or without clinical tophi.     

A case of gouty arthritis to tophi on 18F-FDG PET/CT imaging

We report a case of gouty arthritis with tophi that was evaluated using 18F-fluorodeoxyglucose (FDG) positron emission tomography. A 77-year-old man with a history of gouty attacks was admitted with severe polyarticular pain and fever. 18F-FDG positron emission tomography/CT demonstrated focal uptake at multiple joints, including the juxta-articular soft-tissue-density masses of the elbows, and the bases of bilateral large toes. Gouty arthritis should be considered with focal 18F-FDG uptake in juxta-articular soft-tissue-density masses (tophi) with or without associated erosions.     

Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings

OBJECTIVE: To explore the typical sonographic features of gray-scale and Power Doppler of acute and chronic gouty arthritis in conjunction with radiographic, clinical, and laboratory findings. MATERIALS AND METHODS: All hand, finger, and toe joints of 19 patients with acute and chronic gout were examined with gray-scale and Power Doppler sonography. The number and size of bone changes detected with sonography was compared to radiographic findings. Vascularization of the synovial tissue was scored on Power Doppler (grades 0-3), and was compared with clinical appearance, including swelling, tenderness, and redness (grades 0-3). RESULTS: In acute gout, mild to moderate echogenic periarticular nodules with sonotransmission and hypervascularization of the edematous surrounding soft tissue were found. In chronic gout, tophaceous nodules completely blocked transmission of US wave, leading to strong reflexion and dorsal shadowing in a minority of cases. No significant difference in the detection of large bone changes (>2mm) was found between sonography and radiography. However, gray-scale sonography was significantly more sensitive in the detection of small bone changes (p<0.001). Power Doppler scores were statistically significantly higher than clinical examination scores (p<0.001). DISCUSSION: Sonography is superior to radiographs in evaluating small bone changes. The inflammatory process in joints can be better detected with Power Doppler sonography than with clinical examination. Typical sonographic appearance of acute and in particular of chronic gout might provide clues on gouty arthritis that adds to the information available from conventional radiography, clinical, and laboratory findings.     

丹参川芎嗪注射液联合双氯芬酸纳治疗急性痛风性关节炎疗效及安全性研究

目的探讨丹参川芎嗪注射液联合双氯芬酸纳治疗急性痛风性关节炎的临床疗效与安全性。方法选择2014年9月至2016年5月就诊的急性痛风性关节炎患者30例,给予丹参川芎嗪注射液联合双氯芬酸纳治疗:丹参川芎嗪注射液10 ml与0.9%氯化钠溶液250 ml静脉滴注,1次/d;双氯芬酸纳75 mg口服,2次/d。治疗3 d后评价其疗效。结果本组患者30例,痊愈60.0%(18/30),显效26.7%(8/30),有效13.3%(4/30),无效0例,总有效率100.0%。治疗后,患者关节疼痛与肿胀评分较治疗前明显改善,差异有统计学意义(P<0.05)。所有患者均未出现明显不良反应。结论丹参川芎嗪联合双氯芬酸纳治疗急性痛风性关节炎疗效显著,且起效快、不良反应少。     

MRI features of tuberculosis of peripheral joints

The aim of this article is to present the magnetic resonance imaging (MRI) features of peripheral tubercular arthritis. The clinical presentation of peripheral tubercular arthritis is variable and simulates other chronic inflammatory arthritic disorders. MRI is a highly sensitive technique which demonstrates fine anatomical details and identifies the early changes of arthritis, which are not visible on radiographs. The MRI features of tubercular arthritis include synovitis, effusion, central and peripheral erosions, active and chronic pannus, abscess, bone chips and hypo-intense synovium. These imaging features in an appropriate clinical setting may help in the diagnosis of tubercular arthritis. Early diagnosis and treatment can effectively eliminate the long-term morbidity of joints affected by tuberculosis.