痛风影像诊断-课件.ppt

By Bone Group2013-10-24CASE DISCUSSIONHistoryMale,29YComplaint:bilateral knee pain with intermittent fever for 4 yearsKey signs？Your impression？DDX？Final diagnosisGouty ArthritisBackgroundGout is a form of inflammatory arthritis that is characterized initially by acute attacks of active synovitis related to the presence of monosodium urate(MSU)crystals in the joints and periarticular soft tissues.Accounting for 3-7 in panarthritisMen40 years oldGenetic predispositionPathogenesisMSU crystalsLipidsProteinMucopolysaccharidesThe 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.X-RAYChronicity of the disease processOnly 45,only 6-8 years“Punched out”Until 612 years after the initial acute attackCT82%visible tophiLarge erosions 7.5 mm diameterMRITophiT1WIHomogeneous and generally isointense to muscle T2WIVariedIntermediate to low heterogeneous signal intensityA variable enhancementPeripheral enhancement patternDDXChondrocalcinosis(pseudogout)Rheumatoid arthritis(RA)Pigmented villonodular synovitis（PVNS）ChondrocalcinosisCommonly found in the elderlyMostly occuring in the knee jointDeposition of different types of crystals in the hyaline articular cartilage and/or fibrous cartilage of the menisciPredominant：Calcium pyrophosphate dihydrate(CPPD)Produce severe degenerative joint disease(pyrophosphate arthropathy)Radiologic hallmarksExtensive and diffuse synovial hyperplasia and inflammationSynovial pannus formation Marked enhancement Serious articular cartilage degeneration（Grade or ）Local marginal erosionsObvious local osteoporosisJoint space narrowing in early stage，even fusionPVNSCharacterized 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（villous/nodular/mixed)Nodular variety commonly seen in the tendon sheaths,principally on the volar aspect of the phalangesRadiologic hallmarksVariable extent of synovial proliferationJoint effusion and erosion of boneDeposit of hemosiderin within the synovial massesLow signal on both T1WI and T2WIBest seen on FFE sequenceTreatmentColchicineNot an accurate tool to diagnose gout(psoriatic arthritis&pseudogout)Cold applicationsA useful adjuvant treatment(RA)ConclusionPlain radiographs are less sensitive to early changes in chronic gout than other imaging techniques.CT may be the most specific imaging technique when evaluating intraosseous 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 irreversibility of changes.