43例痛风性关节炎的影像学征象分析

目的探讨痛风性关节炎的影像学表现，提高对早期病变的诊断水平。材料与方法收集一组经临床及病理证实的43例痛风性关节炎的临床及x线、CT及MRI检查资料，根据临床分期，分别对临床早期、中期及晚期患者的影像学资料进行回顾性分析。结果43例中男性37例，女性6例，所有患者血尿酸盐均增高。早期患者5例，均为单关节受累，4例为跖趾关节，1例为膝关节；5例均行x线平片检查，其中2例X线平片阴性；3例x线平片、4例CT检查显示关节周围软组织稍肿胀；2例MRI显示骨髓水肿。18例为中期患者，3例为单关节受累，15例为多关节受累；受累关节邻近软组织肿胀18例，关节积液15例；5例行MRI检查，均显示骨髓水肿存在。晚期病例20例均为多关节受累，穿凿或不规则状骨质破坏20例，痛风石形成20例，关节腔积液5例。初次就诊误诊、漏诊6例，包括早期患者4例，中期2例，均为单关节受累患者。结论痛风性关节炎的影像学表现主要为多关节受累，受累关节的软组织肿胀、穿凿样骨质破坏、痛风石形成；误诊漏诊主要是早期、单关节受累的患者，其影像学表现受累关节局部软组织稍肿胀及骨髓水肿，MRI能对痛风的早期诊断提供重要线索。

Analysis on the Imaging Findings of Gouty Arthritis in 43 Cases

Objective To study the imaging findings of gouty arthritis, and to improve the early diagnostic level of gout. Methods X-ray, CT and MRI examination data of 43 cases with gouty arthritis confirmed by clinical and pathology were retrospectively analyzed according to the clinical stage （early, middle and late clinical stage）. Results Out of all 43 cases, 37 cases were male, and 6 cases were female~ all cases had high level of Mood urate. 5 cases were in early stage, with single affected joint （4 cases in the first metatarsophalangeal joints, and 1 in knee joint）. All 5 cases of early stage patients were performed with X-ray plain film examination, and 2 cases showed negative finding. 3 cases showed positive findings on X-ray film and 4 cases on CT images （soft tissue swelling）; 2 cases showed bone marrow edema on MR images. 18 cases were in middle stage, with 3 cases of single joint affected and 15 cases of multi-joints involved. All 18 cases showed soft tissue swelling, 15 cases showed joint effusion on X ray radiography and CT imaging. Bone marrow edema could be seen on all 5 cases performed with MR imaging. All 20 cases were late stage patients with multi-joints involved and showed farfetched or irregular bone destruction and gouty concretion, and 5 cases showed joint effusion. 6 cases with single affected joint were misdiagnosed and /or missed diagnosed in initial imaging diagnosis, including 4 cases in early stage and 2 cases in middle stage. Conclusion The imaging findings of gouty arthritis include multi-joints involvement, soft tissue swelling of affected joints, farfetched or irregular bone destruction, gouty concretion. Miss diagnosis and/or misdiagnosis mainly occurs in early stage and/or gouty arthritis with single joint affected, and the imaging findings include slight swelling of local soft tissue and bone marrow edema of the affected joints. MRI can provide important clues to the early diagnosis of gouty arthritis.