痛风性膝关节炎MRI表现

目的 探讨膝关节痛风性关节炎的MRI表现及诊断价值。方法 回顾性分析21例经病理证实的膝关节痛风性关节炎患者的临床及MR平扫资料,对其中4例同时行增强扫描,13例行膝关节X线检查,与手术病理进行对照分析。结果 13例行膝关节X线检查患者中,仅2例(2/13,15.38%)出现局限性压迫性骨质破坏。MR平扫14例关节内见多个不定形痛风结节;2例关节内外多发痛风结节;2例膝关节前部皮下单发痛风结节,3例仅表现为关节积液及滑膜轻度增厚。痛风结节T1WI呈等信号,T2WI及PDW脂肪抑制序列图像上为等或稍高信号,位于髌下囊、髌上囊、髁间窝、股骨外侧髁及交叉韧带周围。压迫性骨质破坏12例(12/21,57.14%),2例轻度骨髓水肿。4例MRI增强均表现为边缘明显强化。结论 膝关节X线检查对痛风性关节炎的诊断价值有限,其MRI表现具有一定的特征性。当中老年男性出现膝关节内多发不定形等或稍长T2信号结节、边缘压迫性骨质破坏,无明显骨髓水肿时结合临床可做出正确诊断。

MRI appearance of gouty arthritis of knee

Objective To explore the imaging features of MRI in the patients with gouty arthritis of knee and the diagnostic value. Methods The MR imaging and clinical data of 21 patients with gouty arthritis of the knee confirmed by pathology were retrospectively analyzed. Meanwhile 4 patients underwent enhanced MR scan, 13 patients underwent radiography of the knee. Imaging features were compared with pathologic findings. Results On radiograph images, oppressive bone destruction was observed in 2(2/13, 15.38%). On the plain MR scan in all 21 patients:Multiple amorphous intra-articular tophi(n=14), multiple tophi in extra-articular and intra-articular(n=21), single tophus in the hypoderm of anterior area of the knee joint(n=2), knee joint fluid and synovial membrane slightly thicken(n=3) were observed. Tophi showed intermediate signal on T1WI images and intermediate or slightly high signal on both T2WI images and fat-suppressed proton density weight images; The tophi located in infrapatellar bursa, suprapatellar bursa, intercondylar fossa, and around the lateral femoral condyle and cruciate ligament. Twelve cases(12/21, 57.14%) revealed oppressive bone destruction, 2 cases had slightly bone marrow edema. Obvious peripheral enhancement of the tophi was seen in 4 cases on contrast-enhanced MRI images. Conclusion The diagnostic value of the radiograph on the gouty arthritis of the knee is limite, while MRI appearance may have a few features. When middle-aged or elderly men show the multiple amorphous lesions with isointense or slightly high signal on T2WI and the oppressive destruction at the edge of bone without bone marrow edema, it may suggest the diagnosis of gouty arthritis with combining clinical findings.