痛风影像诊断—培训课件.ppt

RA Characterized by an inflammatory synovitis and a potential to destroy bone and cartilage Mostly seen in middle-aged woman Symmetric distribution RF（+） Radiologic hallmarks Extensive and diffuse synovial hyperplasia and inflammation Synovial pannus formation Marked enhancement Serious articular cartilage degeneration（Grade Ⅲ or Ⅳ ） Local marginal erosions Obvious local osteoporosis Joint space narrowing in early stage，even fusion PVNS Characterized by synovial proliferation and hemosiderin deposition into the synovial tissues of the affected joint Men aged 20-40 years old Mostly seen in knee and ankle joint Proliferation（villous/nodular/mixed) Nodular variety commonly seen in the tendon sheaths, principally on the volar aspect of the phalanges Radiologic hallmarks Variable extent of synovial proliferation Joint effusion and erosion of bone Deposit of hemosiderin within the synovial masses Low signal on both T1WI and T2WI Best seen on FFE sequence Treatment Colchicine Not an accurate tool to diagnose gout(psoriatic arthritispseudogout) Cold applications A useful adjuvant treatment(RA) Conclusion Plain 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. By Bone Group 2013-10-24 CASE DISCUSSION History Male,29Y Complaint:bilateral knee pain with intermittent fever for 4 years Key signs？ Your impression？ DDX？ Laboratory examination Uric Acid（UA）：478.3μmol/L↑ Treatment Allopurinol（ALLO） Final diagnosis Gouty Arthritis Background Gout 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 periarticul