足踝部X线表现阴性痛风性关节炎的CT与MRI表现对比研究  

Comparison of CT and MRI in patients with gout who have normal plain radiography in foot and ankle

作　　者：孙德政[1] 杨青[1] 胡亚彬[1] 段峰[1] 于华龙[1] 刘世合[1] 

机构地区：[1]青岛大学医学院附属医院东院放射科,山东青岛266071

出　　处：《中国中西医结合影像学杂志》2014年第3期244-247,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：山东省科技发展计划资助项目(2011GSF11834)

摘　　要：目的:对足踝部X线平片表现阴性痛风患者的CT和MRI表现进行对比研究,评估其隐匿性骨质破坏及其他影像学表现。方法:收集于我院就诊的36例X线平片阴性痛风患者,于2周内均行CT与MRI平扫,分析骨质破坏、关节内和/(或)周围痛风石、软组织肿胀、关节腔积液、滑膜增厚和骨髓水肿等征象。结果:36例CT平扫可见骨质破坏23例,MRI可见13例,二者差异有统计学意义(P=0.002)。CT平扫可见关节内和/(或)周围痛风石23例,MRI可见27例,二者差异无统计学意义(P=0.289);其中21例CT、MRI均见痛风石表现,6例仅MRI可见,2例仅CT可见。CT与MRI平扫分别有11例和15例可见关节腔积液表现,二者差异无统计学意义(P=0.125)。2种检查均见软组织肿胀24例,差异无统计学意义(P=1.000)。另外,36例的MRI平扫中,4例可见滑膜增厚,30例见骨髓水肿表现。结论:CT与MRI平扫可显示X线平片无法显示的隐匿性骨质破坏及微小痛风石,CT平扫对于早期骨质破坏的显示优于MRI,但MRI可提供更多影像信息。对于足踝部X线表现阴性痛风性关节炎,CT与MRI相结合为最佳检查手段。Objective：To compare CT and MRI findings in gouty patients who have normal plain radiography in foot and ankle, and to assess the occult bone destruction,as well as relative imaging findings of gouty arthritis. Methods： 36 patients with a documented diagnosis of gout whose X-ray were normal were screened out in the hospital. The selected patients all underwent CT and MRI scans during two weeks, and were analyzed bone erosion, the tophi in and/or around the articulation, soft tissue edema, joint effusion, synovial pannus and bone marrow edema, respectively. Results： 23/36 （63.9%） patients had visible bone destruction in CT,while only 13/36 （36.1%） in MRI（P=0. 002）. 23/36 （63.9%） cases were found tophi in soft tissue and/or around the articulation by CT,while 27/36 （75.0%） by MRI （P=0. 289）. 6 cases with normal CT,displayed tophi deposition on MRI, in contrast,2 patients with normal MR were detected tophi by CT. Respectively,there were 11 and 15 cases displaying joint effusion in CT and MRI （P= 0. 125）. Soft tissue swelling detected by CT and MRI were equivalent （ n = 24, P= 1）. Besides, MRI scan revealed 4 patients with synovial pannus and 30 patients with bone marrow edema. Conclusions： CT and MR scan can detect occult bone destruction which could not be shown in X-rays. CT is prior to MR on detecting early erosive changes. In all, combining CT with MRI is considered as best mean for patients with gout who have normal plain radiography in foot and ankle.

关 键 词：关节炎 痛风性 跖趾关节 踝关节 体层摄影术 X线计算机 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R816.8[医药卫生—诊断学] R589.7[医药卫生—临床医学]