Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography
Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography
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DOI：
10.1136/ard.61.1.52
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发表时间：
2002-01-01
影响因子：
27.4
通讯作者：
Meuwly, JY
中科院分区：
文献类型：
--
作者：
Gerster, JC;Landry, M;Meuwly, JY
目的：探讨计算机断层扫描（CT）、磁共振成像（MRI）和多普勒超声（US）对痛风性痛风的诊断价值。方法：对4例男性慢性痛风伴痛风影响膝关节（3例）或肘关节鹰嘴突（1例）的患者进行评价。用偏光显微镜、茜素红染色和x射线衍射对感兴趣区域的滑液或组织吸出物进行晶体学分析。采用GE扫描CT， 1.5 T磁通（Siemens）磁共振成像，标准技术彩色多普勒超声检查。结果：晶体学分析显示4例患者标本中存在尿酸钠（MSU）晶体；未见羟基磷灰石和焦磷酸钙二水合结晶。x线平片可见弥漫性软组织增厚，但未见胼胝体钙化或骨化。CT显示病变包含圆形和椭圆形阴影，平均密度约160 Hounsfield单位（HU）。MRI显示病灶在T上呈低至中等信号强度，T为加权。2例注射造影剂后，1例眼窝增强。彩色多普勒超声显示三例耳石低回声伴外周血流量增高。结论：核磁共振和彩色多普勒超声显示痛风石肿块周围有血管增生区，不能认为是痛风的特异性表现。但在CT图像上，可以清楚地看到约160 HU密度的肿块，与MSU晶体沉积相对应。
Objective: To determine the usefulness of computed tomography (CT), magnetic resonance imaging (MRI), and Doppler ultrasonography (US) in providing specific images of gouty tophi.Methods: Four male patients with chronic gout with tophi affecting the knee joints (three cases) or the olecranon processes of the elbows (one case) were assessed. Crystallographic analyses of the synovial fluid or tissue aspirates of the areas of interest were made with polarising light microscopy, alizarin red staining, and x ray diffraction. CT was performed with a GE scanner, MR imaging was obtained with a 1.5 T Magneton (Siemens), and ultrasonography with colour Doppler was carried out by standard technique.Results: Crystallographic analyses showed monosodium urate (MSU) crystals in the specimens of the four patients; hydroxyapatite and calcium pyrophosphate dihydrate (CPPD) crystals were not found. A diffuse soft tissue thickening was seen on plain radiographs but no calcifications or ossifications of the tophi. CT disclosed lesions containing round and oval opacities, with a mean density of about 160 Hounsfield units (HU). With MRI, lesions were of low to intermediate signal intensity on T, and T, weighting. After contrast injection in two cases, enhancement of the tophus was seen in one. Colour Doppler US showed the tophi to be hypoechogenic with peripheral increase of the blood flow in three cases.Conclusion: The MR and colour Doppler US images showed the tophi as masses surrounded by a hypervascular area, which cannot be considered as specific for gout. But on CT images, masses of about 160 HU density were clearly seen, which correspond to MSU crystal deposits.