痛風(fēng)影像診斷

1、By Bone Group2013-10-24,CASE DISCUSSION,History,Male,29YComplaint:bilateral knee pain with intermittent fever for 4 years,,,,,,,,,,,,Key signs？Your impression？DDX？,,Laboratory examinationUric Acid（UA）：478.3μmol/L↑T

2、reatmentAllopurinol（ALLO）,Final diagnosis,Gouty Arthritis,Background,Gout is a form of inflammatory arthritis that is characterized initially by acute attacks of active synovitis related to the presence of monosodium ur

3、ate (MSU) crystals in the joints and periarticular soft tissues.Accounting for 3-7％ in panarthritisMen＞40 years oldGenetic predisposition,Background,Most classically in the first metatarsophalangeal joint (toe)A hist

4、ory of underlying renal disease or use of medications that cause hyperuricemiaGold standard : monosodium urate (MSU) crystals in the joint fluid or tophus,Pathogenesis,MSU crystalsLipidsProteinMucopolysaccharidesThe

5、 tophus eroding the underlying bone is pivotal in the development of bone erosions in gouty arthritis.MSU crystal deposition is associated with the presence of underlying OA.,Radiologic hallmarks,Presence of macroscopic

6、 tophiNormal mineralizationRelative joint space preservationErosions with overhanging edgesA gradually expanding tophus eroding at the bone cortex with concomitant new periosteal bone formation trying to contain the

7、tophusAsymmetric polyarticular distribution,X-RAY,Chronicity of the disease processOnly 45％,only 6-8 years“Punched out”Until 6–12 years after the initial acute attack,,,,CT,82% visible tophiLarge erosions >7.5 m

8、m diameter,,,,,,MRI——Tophi,T1WIHomogeneous and generally isointense to muscle T2WIVariedIntermediate to low heterogeneous signal intensityA variable enhancementPeripheral enhancement pattern,,,,,,,DDX,Chondrocalcin

9、osis (pseudogout)Rheumatoid arthritis (RA)Pigmented villonodular synovitis（PVNS）,Chondrocalcinosis,Commonly found in the elderlyMostly occuring in the knee jointDeposition of different types of crystals in the hyalin

10、e articular cartilage and/or fibrous cartilage of the menisciPredominant：Calcium pyrophosphate dihydrate (CPPD)Produce severe degenerative joint disease (pyrophosphate arthropathy),Radiographic hallmarks,Articular and

11、periarticular calcificationOnly involving 1 or 2 jointsDiscrete areas of low signal intensity within the articular cartilageMore apparent on GRE sequencesJoint space narrowing Subchondral osteosclerosisArticular su

12、rface subsidence,,,,,RA,Characterized by an inflammatory synovitis and a potential to destroy bone and cartilageMostly seen in middle-aged womanSymmetric distributionRF（+）,Radiologic hallmarks,Extensive and diffuse sy

13、novial hyperplasia and inflammationSynovial pannus formation Marked enhancement Serious articular cartilage degeneration（Grade Ⅲ or Ⅳ ）Local marginal erosionsObvious local osteoporosisJoint space narrowing in earl

14、y stage，even fusion,,,,,,PVNS,Characterized by synovial proliferation and hemosiderin deposition into the synovial tissues of the affected jointMen aged 20-40 years oldMostly seen in knee and ankle jointProliferation（

15、villous/nodular/mixed)Nodular variety commonly seen in the tendon sheaths, principally on the volar aspect of the phalanges,Radiologic hallmarks,Variable extent of synovial proliferationJoint effusion and erosion of bo

16、neDeposit of hemosiderin within the synovial massesLow signal on both T1WI and T2WIBest seen on FFE sequence,,,,Treatment,ColchicineNot an accurate tool to diagnose gout(psoriatic arthritis&pseudogout)Cold appli

17、cationsA useful adjuvant treatment(RA),Conclusion,Plain radiographs are less sensitive to early changes in chronic gout than other imaging techniques. CT may be the most specific imaging technique when evaluating intra

18、osseous lesions, while MRI could be the preferred technique to evaluate chronic synovial involvement.The presence of structural changes in radiographs correlates with poor function, and is associated with irreversibilit