Guangdong, Department of Radiology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated with Guangzhou University of Chinese Medicine, Zhongshan, 528400, Guangdong, People's Republic of China.
Guangdong, Department of Ultrasonography, Zhongshan Hospital of Traditional Chinese Medicine Affiliated with Guangzhou University of Chinese Medicine, Zhongshan, 528400, Guangdong, People's Republic of China.
BMC Med Imaging. 2022 Sep 14;22(1):167. doi: 10.1186/s12880-022-00894-3.
We aimed to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of gouty arthritis primarily involving the large joints of the upper limbs, signal or density characteristics of the tophi, growth patterns, involvement of the adjacent joints, and differentiation from other lesions occurring in this area and to discuss the causes of misdiagnosis.
CT and MRI data were collected from 14 patients with gouty arthritis, primarily involving the shoulder and elbow joints, and their imaging features were analyzed.
All the patiens were ranged from 28-85 years old, and the tophi deposition can be observed on either CT or MRI.The tophi deposition apperas as slightly higher density nodules or masses on CT images,or nodules or masses on MRI with isosignal/hypointensity on T1WI and hyperintensity on T2WI. Five patients showed narrowing of the affected joint space, four had different degrees of bone erosion under the articular surface, eight developed joint effusion, and all showed surrounding soft tissue swelling. The tophi grew around the joint, with anterolateral and posterolateral tophi predominantly in the shoulder joint and dorsal tophi predominantly in the elbow joint on the MRI, with compression and edema of the surrounding soft tissues.
Gouty arthritis occurs in the large joints of the upper limbs and is characterized by fluid accumulation in the joint capsule and the formation of tophi. These tophi are usually large, with subcutaneous bone resorption and erosion, with or without cartilage destruction. However, extensive edema appeared in the soft tissue around the tophi, but the edema only produced pressure without any obvious signs of soft tissue infiltration, which may be distinguished from the joint tumor. In addition, the gout incidence rate is increased in young patients. Therefore, when the patient has a large joint mass, it is important to confirm whether there is a history of gout.
本研究旨在分析主要累及上肢大关节的痛风性关节炎的 CT 和 MRI 表现，包括痛风石的信号或密度特征、生长方式、累及的相邻关节，以及与该区域内其他病变的鉴别诊断，并探讨误诊原因。
收集 14 例主要累及肩、肘关节的痛风性关节炎患者的 CT 和 MRI 资料，分析其影像学特征。
14 例患者年龄 28-85 岁，CT 或 MRI 均可见痛风石沉积。CT 图像上，痛风石沉积表现为略高密度结节或肿块；MRI 上呈结节或肿块样，T1WI 呈等信号/低信号，T2WI 呈高信号。5 例关节间隙变窄，4 例关节面下不同程度骨质侵蚀，8 例关节腔积液，均有周围软组织肿胀。痛风石围绕关节生长，MRI 上肩关节炎以盂肱前外侧、后外侧多见，肱桡后外侧多见，周围软组织受压水肿；肘关节以背侧多见，呈分叶状，周围软组织水肿明显，伸肌腱受压。
上肢大关节痛风性关节炎以关节囊积液、痛风石形成为特征。痛风石通常较大，可伴有皮下骨质吸收、侵蚀，可合并或不合并软骨破坏。但痛风石周围软组织广泛水肿，仅产生压迫而无明显软组织浸润征象，有助于与关节肿瘤相鉴别。此外，年轻患者痛风发病率增加，故当患者出现大关节肿块时，应注意确认是否有痛风病史。
