影像学技术在痛风诊断及疾病监测中的应用研究进展

doi:10.16150/j.1671-2870.2023.03.17

摘要/Abstract

摘要：

痛风是一种单钠尿酸盐（monosodium urate, MSU）沉积在关节所致的关节病变，其与高尿酸血症直接相关，属于代谢性风湿病的一种。在全球范围内，欧洲的痛风患病率为0.9%~2.5%，美国的患病率2007年至2010年为3.76%。在我国，关于痛风的流线病学报告都是地区性的，目前还没有研究对全国患病情况进行过调查。根据不同地区、不同年代的调查表明，目前我国痛风的患病率为1%~3%，并呈逐年上升趋势。我国的痛风患者虽然并不少见，但其规范化诊断与监测依然欠缺。随着影像学技术的不断发展，不同的影像学检查对于痛风疾病的诊断、监测的研究也愈发深入，关节X线平片摄影可以观察到关节软骨下骨质破坏，操作简单，价格便宜，适合基层医疗机构对于疾病的诊治；超声检查对慢性痛风石关节炎患者的诊断也有很高的特异度，可以诊断尿酸沉积。近年来，双能CT技术越来越普及，其识别尿酸盐结晶具有非常高的特异性，三维重建技术也在痛风结石的可视化成像上得以应用，成为临床上重要的诊断技术；光子计数探测器CT（photon-counting detector CT，PCD‐CT）是近年来CT领域最新的突破性技术，具有多能谱采集、辐射剂量极低的特点，对于痛风结石在关节沉积的显示、疾病的检测都有非常大的潜力。本文论述近年来国内外多种影像学技术在痛风诊断中研究的进展，对各种影像学检查的特异度和灵敏度进行了总结，并对光子技术探测器CT技术在痛风领域的应用进行了展望。

关键词: 痛风, 类风湿关节炎, 痛风性关节炎, 双能量CT, 鉴别诊断, 磁共振成像

Abstract:

Gout is a common metabolic rheumatism. The main cause is the increase of blood uric acid caused by the disorder of purine metabolism in the body. Long-term persistent hyperuricemia will lead to the precipitation of monosodium urate (monosodium urate, MSU) crystals, which will form and deposit in the internal and external tissues of the joints. Due to the action of inflammatory factors, eventually gouty arthritis. Gout is a widespread disease worldwide, and the prevalence of gout in my country is increasing year by year. Gout is a chronic disease that is often characterized by extreme pain in its acute phase and, in some cases, invades the bone, leading to bone erosion and destruction. Complications of chronic gout include severe bone and joint damage, necrotizing swelling of soft tissue, and bone infection. In severe cases, it can even cause tendon rupture and loss of joint function. Gout is an important disease that seriously endangers the health of the Chinese people. Early diagnosis and intervention of gout are very important. Imaging is not only helpful in diagnosing gout, but can also be used as a monitoring method to evaluate the disease and the effect of uric acid-lowering therapy. Dual-energy CT technology is the most promising technology for non-invasive diagnosis and disease monitoring, and MRI texture analysis technology can also assist in the differential diagnosis of gouty arthritis. This review discusses the role of various imaging tests in gout, focusing on the role of imaging features in gout diagnosis and disease monitoring.

Key words: Gout, Rheumatoid arthritis, Guty arthritis, Dual energy CT, Differential diagnosis, Magnetic resonance imaging

中图分类号:

R589

李笑石, 秦越. 影像学技术在痛风诊断及疾病监测中的应用研究进展[J]. 诊断学理论与实践, 2023, 22(03): 311-318.

LI Xiaoshi, QIN Yue. Multiple radiology imaging techniques in the diagnosis of gout[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(03): 311-318.

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影像学检查	优势	劣势
X线平片摄影	价格低廉	灵敏度低
	基层医院设备充足	在检测骨质破坏方面不如MRI准确
	特异性高	特异性特征出现在疾病晚期
		无法检测其他特征，包括MSU晶体沉积
MRI	能够检测皮下和深层组织内的痛风石	检查费用昂贵
		基层或社区医院缺少设备
		无法直接可视化MSU晶体沉积
双能量CT	可以直接观察到MSU晶体沉积	具有电离辐射
	特异性及敏感性都很高	痛风疾病早期敏感性没有统一标准
	诊断难度较小，可以引入人工智能技术

影像学检查	特异度	灵敏度
X线平片摄影	93%	31%
MRI	91%	90%
双能量CT	79%~100%	78%~100%
超声	69.6%	92%
核医学	55.5%	56.9%