膝关节痛风性关节炎的MRI诊断

作者单位:528000广东省佛山市中医院放射科

ü骨骼肌肉放射学þ

膝关节痛风性关节炎的MRI 诊断

夏成德,樊长姝,赵小梅,方挺松

=摘要> 目的 探讨膝关节痛风性关节炎的M R I 特征性表现。资料与方法 回顾性分析7例经手术、病理证实为膝关节痛风性关节炎的M R I 表现。所有病例均做SE 序列T 1W I 和FSE 序列T 2W I 。其中4例做了钆喷酸葡胺(Gd -DTPA )增强扫描。结果 膝关节骨质侵蚀破坏5例,股骨髁4例,髌骨下缘1例;股骨髁间窝区域、髌下脂肪区和/或髌韧带周围软组织见团块状病灶6例。全部痛风石病灶T 1W I 均呈低至中等信号;T 2W I 有2例呈低信号,3例有低信号病灶和低至稍高混杂信号病灶,另2例则为高信号。4例增强后,病灶无强化1例,轻度不均匀强化1例,病灶边缘强化2例。结论 膝关节痛风性关节炎的M R I 特征性表现常是T 1W I 和T 2W I 均呈低至中等信号的肿块状病灶,且具边缘强化,其对膝关节痛风性关节炎的诊断很有价值。=关键词> 痛风 关节炎 磁共振成像 膝关节

MR D iagnosis of Gouty Art hritis in t he Knee

X IA Chengde ,FAN Changshu ,Z HAO X iao m e,i et al 1

Depart m ent o fRadiolgy ,Foshan T raditi o na l Ch i n ese M edic i n e H ospita,l

Foshan ,Guangdong Prov i n ce 528000,P .R.Ch i n a

=Abstract > O bjective T o discuss M R I cha racter istic features of gouty arthritis i n the knee .M a terials and M eth -ods M R I find i ng s of 7pati ents w ith s u rg ica l and patho l og i ca l proved gouty art h ritis o f the knee w ere retrospecti ve ly re -v ie w ed .A ll patients underwent knee M R I pla i n scan w it h SE T 1W I and F SE T 2W I sequence .SE sequence T 1W I w as ob -ta i ned a fter I V ad m i n tra ti on o fG d -DTPA i n 4pa ti ents .R esu lts 5patien ts had bone ero si on in t he knee ,4pa ti ents i n the fe m ora l condy l es ,1patient in the pate lla ,6pati ents had the soft ti ssue m asses i n t he i ntercondy lar no tch and in t he subpa -tellar fa t area or /and around the pa tellar li g a m ent .A ll the gouty toph i de m onstrated hypo i ntensity to iso i ntensity s i gna l on T 1W I .T he gouty tophi i n 2patients demonstra ted hypointensity s i gna l on T 2W I ,the gou t y toph i i n 3patients de m onstrated hypo i ntensity or heterogeneous hypo i ntensity to sligh tly hype ri ntensity si gna l on T 2W I and i n 2patients demonstra ted hype r -i n tensity signa l on T 2W I .A fter contrast ad m i nistrati on i n 4pati ents ,t he gouty tophi i n 1pati ent demonstrated no enhance -m en,t the gouty tophi i n 1patient w it h sli ghtl y hete rogeneous enhance m ent and in 2pa ti ents w it h per i pheral enhance m ent .Conc l u sion M R I characte ristic features o f gouty arthritis of the knee o ften presen t as m asses o f hypo to iso i ntensity on both T 1W I and T 2W I w it h periphera l enhance m en t ,wh i ch are he l pful i n t he diago si s of gout arthr i tis o f the knee .=K ey words > G out A rthr i tis M agneti c resonance i m ag ing K nee

痛风性关节炎是人体内嘌呤代谢异常引起的血尿酸浓度增高而导致反复发作的急性或慢性关节炎

的疾病。随着人们生活水平的提高,发病率日渐增高。膝关节痛风性关节炎的临床诊断主要是靠血尿酸实验室检查,可是膝关节痛风性关节炎在临床可能以感染样或肿瘤样的不典型方式出现,因此影像学检查对其诊断是有帮助的,痛风性关节炎的X 线诊断已有不少研究,关于其磁共振影像学方面的研究,国内还未见报道

[1~4]

。笔者就本院1998年7月

至2006年10月行MR I 检查并经手术病理证实的7例膝关节痛风性关节炎病例进行分析,重点讨论其MR I 表现和诊断价值。

1 资料与方法

本组7例中,6例行膝关节镜手术,另1例行病灶清除手术,均经术后病理证实,其中男6例,女1例,发病年龄38~81岁(平均52岁)。就诊原因:已知有痛风病史来就诊2例,以膝关节反复疼痛就诊3例,以外伤后膝关节疼痛就诊2例。合并有慢性肾功能损害1例,膝关节退行性病变2例。本组