课件:痛风影像诊断.ppt_第1页
课件:痛风影像诊断.ppt_第2页
课件:痛风影像诊断.ppt_第3页
课件:痛风影像诊断.ppt_第4页
课件:痛风影像诊断.ppt_第5页
已阅读5页,还剩40页未读 继续免费阅读

下载本文档

版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领

文档简介

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):478.3mol/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 periarticular soft tissues. Accounting for 3-7 in panarthritis Men40 years old Genetic predisposition,Background,Most classically in the first metatarsophalangeal joint (toe) A history of underlying renal disease or use of medications that cause hyperuricemia Gold standard : monosodium urate (MSU) crystals in the joint fluid or tophus,Pathogenesis,MSU crystals Lipids Protein Mucopolysaccharides The 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.,Radiologic hallmarks,Presence of macroscopic tophi Normal mineralization Relative joint space preservation Erosions with overhanging edges A gradually expanding tophus eroding at the bone cortex with concomitant new periosteal bone formation trying to contain the tophus Asymmetric polyarticular distribution,X-RAY,Chronicity of the disease process Only 45,only 6-8 years “Punched out” Until 612 years after the initial acute attack,CT,82% visible tophi Large erosions 7.5 mm diameter,MRITophi,T1WI Homogeneous and generally isointense to muscle T2WI Varied Intermediate to low heterogeneous signal intensity A variable enhancement Peripheral enhancement pattern,DDX,Chondrocalcinosis (pseudogout) Rheumatoid arthritis (RA) Pigmented villonodular synovitis(PVNS),Chondrocalcinosis,Commonly found in the elderly Mostly occuring in the knee joint Deposition of different types of crystals in the hyaline articular cartilage and/or fibrous cartilage of the menisci Predominant:Calcium pyrophosphate dihydrate (CPPD) Produce severe degenerative joint disease (pyrophosphate arthropathy),Radiographic hallmarks,Articular and periarticular calcification Only involving 1 or 2 joints Discrete areas of low signal intensity within the articular cartilage More apparent on GRE sequences Joint space narrowing Subchondral osteosclerosis Articular surface subsidence,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 or ) 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 arthritis&pseudogout) 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.,后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用,主要经营:网络软件设计、图文设计制作、发布广告等 公司秉着以优质的服务对待每一位客

温馨提示

  • 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
  • 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
  • 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
  • 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
  • 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
  • 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
  • 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。

评论

0/150

提交评论