De Avila Fernandes Eloy, Bergamaschi Samuel Brighenti, Rodrigues Tatiane Cantarelli, Dias Gustavo Coelho, Malmann Ralff, Ramos Germano Martins, Monteiro Soraya Silveira
Hospital do Servidor Público Estadual (Iamspe), São Paulo, SP, Brazil; Universidade Federal de São Paulo (Unifesp), Departamento de Diagnóstico por Imagem, São Paulo, SP, Brazil.
Hospital do Servidor Público Estadual (Iamspe), São Paulo, SP, Brazil.
Rev Bras Reumatol Engl Ed. 2017 Jan-Feb;57(1):64-72. doi: 10.1016/j.rbre.2016.05.001. Epub 2016 Jun 24.
Gout is an inflammatory arthritis characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues leading to inflammation. Men are more commonly affected, mainly after the 5th decade of life. Its incidence has been growing with the population aging. In the majority of the cases, the diagnosis is made by clinical criteria and synovial fluid analysis, in search for monosodium urate crystals. Nonetheless, gout may sometimes have atypical presentations, complicating the diagnosis. In these situations, imaging methods have a fundamental role, aiding in the diagnostic confirmation or excluding other possible differential diagnosis. Conventional radiographs are still the most commonly used method in gout patients' evaluation; nevertheless, this is not a sensitive method, since it detect only late alterations. In the last years, there have been several advances in imaging methods for gout patients. Ultrasound has shown a great accuracy in the diagnosis of gout, identifying monosodium urate deposits in the synovial membrane and articular cartilage, in detecting and characterizing tophi and in identifying tophaceous tendinopathy and enthesopathy. Ultrasound has also been able to show crystal deposition in patients with articular pain in the absence of a classical gout crisis. Computed tomography is an excellent method for detecting bone erosions, being useful in spine involvement. Dual-energy CT is a new method able to provide information about the chemical composition of tissues, with high accuracy in the identification of monosodium urate deposits, even in the early stages of the disease and in cases of difficult characterization. Magnetic resonance imaging is useful in the evaluation of deep tissues not accessible by ultrasound. Besides the diagnosis, with the emergence of new drugs that aim to reduce tophaceous burden, imaging methods have become useful tools in monitoring the treatment of patients with gout.
痛风是一种炎症性关节炎，其特征是滑膜、关节软骨和关节周围组织中尿酸钠晶体沉积，导致炎症。男性更易受累，主要在50岁以后。随着人口老龄化，其发病率一直在上升。在大多数情况下，通过临床标准和滑液分析来诊断，以寻找尿酸钠晶体。然而，痛风有时可能有非典型表现，使诊断复杂化。在这些情况下，影像学方法起着至关重要的作用，有助于确诊或排除其他可能的鉴别诊断。传统X线片仍是痛风患者评估中最常用的方法；然而，这不是一种敏感的方法，因为它只能检测到晚期改变。近年来，痛风患者的影像学方法有了一些进展。超声在痛风诊断中显示出很高的准确性，能识别滑膜和关节软骨中的尿酸钠沉积，检测和表征痛风石以及识别痛风性肌腱病和附着点病。超声还能够在没有典型痛风发作的关节疼痛患者中显示晶体沉积。计算机断层扫描是检测骨侵蚀的优秀方法，对脊柱受累情况很有用。双能CT是一种能够提供组织化学成分信息的新方法，在识别尿酸钠沉积方面具有很高的准确性，即使在疾病早期和难以表征的情况下也是如此。磁共振成像在评估超声无法触及的深部组织方面很有用。除了诊断之外，随着旨在减轻痛风石负担的新药的出现，影像学方法已成为监测痛风患者治疗的有用工具。
