膝关节痛风石的磁共振表现
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摘要
目的探讨膝关节内痛风石的磁共振成像(MRI)表现,提高对该病的认识。方法回顾性分析经手术病理证实的30例膝关节痛风石临床及影像资料,评价每处痛风石造成的损害位置、关节变形、信号强度和相关的骨破坏或骨内损害。结果痛风石沉淀主要位于髌下脂肪垫的中部和前隐窝(n=28)、股骨外侧踝外缘间隙(n=25)、髁间窝(n=22)。所有痛风性损害表现为相似信号特点(T1加权像上为低到中等信号强度,T2加权像上为不均匀信号强度),可见3种病损形式:无定型的团块(n=27)、线型晶体状沉淀(n=6)、膝关节囊损害(n=3)。相关的骨破坏发生在股骨外侧踝的外缘者有8例,发生在髁间窝顶部者有7例,发生在胫骨粗隆者有5例,发生在胫骨粗隆中部和外侧的有3例,发生在髌骨的有1例。结论 MRI能清楚显示痛风石形成的位置和相关的损害,可以提高该病的诊断正确率。
[Objective] To improve the recognition of tophaceous gout in the knee by exploring the MRI features of the disease. [Methods] We retrospectively analyzed the clinical and imaging data of 30 cases with gouty tophi, which were confirmed by surgery and pathology. Each tophaceous lesion was evaluated for location,morphology,signal intensity,and associated bone erosion or intraosseous involvement.[Results] The tophaceous masses were commonly located on the medial aspect of the infrapatellar fat pad and anterior joint recess(n =28),the space adjacent to the lateral rim of the lateral femoral condyle(n =25), and the intercondylar fossae(n =22). All tophaceous lesions showed similar signal characteristics(low-intermediate signal intensities on T1-weighted images, with heterogeneous signal intensities on T2-weighted images), and 3 morphologic patterns were observed:amorphous masses(n =27), linear crystalline-like deposits(n =6), and cystic lesions of the bursae around the knee(n =3). Associated bone erosions occurred in the lateral rim of the lateral femoral condyle(n =8), the roof of the intercondylar notch(n =7), the tibial eminence(n =5), and the medial and lateral rim of the tibial plateau(n =3). Intraosseous tophi were seen in the tibial plateau(n =3)and patella(n =1).[Conclusion] MRI can display the common locations and associated erosions of tophaceous gout and its characteristic MR appearance may facilitate its correct diagnosis with magnetic resonance imaging.
[Objective] To improve the recognition of tophaceous gout in the knee by exploring the MRI features of the disease. [Methods] We retrospectively analyzed the clinical and imaging data of 30 cases with gouty tophi, which were confirmed by surgery and pathology. Each tophaceous lesion was evaluated for location,morphology,signal intensity,and associated bone erosion or intraosseous involvement.[Results] The tophaceous masses were commonly located on the medial aspect of the infrapatellar fat pad and anterior joint recess(n =28),the space adjacent to the lateral rim of the lateral femoral condyle(n =25), and the intercondylar fossae(n =22). All tophaceous lesions showed similar signal characteristics(low-intermediate signal intensities on T1-weighted images, with heterogeneous signal intensities on T2-weighted images), and 3 morphologic patterns were observed:amorphous masses(n =27), linear crystalline-like deposits(n =6), and cystic lesions of the bursae around the knee(n =3). Associated bone erosions occurred in the lateral rim of the lateral femoral condyle(n =8), the roof of the intercondylar notch(n =7), the tibial eminence(n =5), and the medial and lateral rim of the tibial plateau(n =3). Intraosseous tophi were seen in the tibial plateau(n =3)and patella(n =1).[Conclusion] MRI can display the common locations and associated erosions of tophaceous gout and its characteristic MR appearance may facilitate its correct diagnosis with magnetic resonance imaging.
引文
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[11]孙德政,杨青,胡亚彬,等.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[J].中国中西医结合影像学杂志,2014,12(3):244-247.
[12]马立恒,彭振鹏,张朝晖,等.膝关节滑膜病变的MR诊断及鉴别诊断[J].中国医学计算机成像杂志,2011,17(1):59-64.
[13]陈平有,李小力,陈学强,等.透析相关性淀粉样变骨关节病的影像学表现(附28例分析)[J].医学影像学杂志,2012,22(3):452-456.
[2]李建,范国光,徐克,等.膝关节腱鞘巨细胞瘤与色素沉着绒毛结节性滑膜炎的MRI分析[J].中国医学影像技术,2013(3):446-450.
[3]梁立锋.膝关节滑膜疾病MRI表现分析[J].医学影像学杂志,2017,27(4):740-744.
[4]Gersing AS,Schwaiger BJ,Heilmeier U,et al.Evaluation of chondrocalcinosis and associated knee joint degeneration using MRimaging:data from the osteoarthritis initiative[J].Eur Radiol,2017,27(6):2497-2506.
[5]Muhle C,Ahn JM,Dieke C.Diagnosis of ACL and meniscal injuries:MR imaging of knee flexion versus extension compared to arthroscopy[J].Springerplus,2013,2(1):213-213.
[6]House CV,Connell DA,Saifuddin A.Posteromedial corner injuries of the knee[J].Clin Radiol,2007,62(6):539-546.
[7]袁艳平,李长贵.急性痛风性关节炎的规范化治疗[J].医学综述,2014,20(21):3902-3905.
[8]王旭,刘斌.痛风性关节炎的影像学诊断及进展[J].国际医学放射学杂志,2012,35(3):251-254.
[9]漆强,邹玉林,余晖,等.痛风性关节炎的X线、CT和MRI诊断价值比较[J].中国临床医学影像杂志,2015,26(7):523-527.
[10]陈对梅,汪青山,陈文静,等.MRI对痛风性关节炎的诊断[J].放射学实践,2015,30(10):1040-1043.
[11]孙德政,杨青,胡亚彬,等.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[J].中国中西医结合影像学杂志,2014,12(3):244-247.
[12]马立恒,彭振鹏,张朝晖,等.膝关节滑膜病变的MR诊断及鉴别诊断[J].中国医学计算机成像杂志,2011,17(1):59-64.
[13]陈平有,李小力,陈学强,等.透析相关性淀粉样变骨关节病的影像学表现(附28例分析)[J].医学影像学杂志,2012,22(3):452-456.