痛风影像诊断ppt课件.ppt

ByBoneGroup2013 10 24 CASEDISCUSSION History Male 29YComplaint bilateralkneepainwithintermittentfeverfor4years Keysigns Yourimpression DDX LaboratoryexaminationUricAcid UA 478 3 mol L TreatmentAllopurinol ALLO Finaldiagnosis GoutyArthritis Background Goutisaformofinflammatoryarthritisthatischaracterizedinitiallybyacuteattacksofactivesynovitisrelatedtothepresenceofmonosodiumurate MSU crystalsinthejointsandperiarticularsofttissues Accountingfor3 7 inpanarthritisMen 40yearsoldGeneticpredisposition Background Mostclassicallyinthefirstmetatarsophalangealjoint toe AhistoryofunderlyingrenaldiseaseoruseofmedicationsthatcausehyperuricemiaGoldstandard monosodiumurate MSU crystalsinthejointfluidortophus Pathogenesis MSUcrystalsLipidsProteinMucopolysaccharidesThetophuserodingtheunderlyingboneispivotalinthedevelopmentofboneerosionsingoutyarthritis MSUcrystaldepositionisassociatedwiththepresenceofunderlyingOA Radiologichallmarks PresenceofmacroscopictophiNormalmineralizationRelativejointspacepreservationErosionswithoverhangingedgesAgraduallyexpandingtophuserodingatthebonecortexwithconcomitantnewperiostealboneformationtryingtocontainthetophusAsymmetricpolyarticulardistribution X RAY ChronicityofthediseaseprocessOnly45 only6 8years Punchedout Until6 12yearsaftertheinitialacuteattack CT 82 visibletophiLargeerosions 7 5mmdiameter MRI Tophi T1WIHomogeneousandgenerallyisointensetomuscleT2WIVariedIntermediatetolowheterogeneoussignalintensityAvariableenhancementPeripheralenhancementpattern DDX Chondrocalcinosis pseudogout Rheumatoidarthritis RA Pigmentedvillonodularsynovitis PVNS Chondrocalcinosis CommonlyfoundintheelderlyMostlyoccuringinthekneejointDepositionofdifferenttypesofcrystalsinthehyalinearticularcartilageand orfibrouscartilageofthemenisciPredominant Calciumpyrophosphatedihydrate CPPD Produceseveredegenerativejointdisease pyrophosphatearthropathy Radiographichallmarks ArticularandperiarticularcalcificationOnlyinvolving1or2jointsDiscreteareasoflowsignalintensitywithinthearticularcartilageMoreapparentonGREsequencesJointspacenarrowingSubchondralosteosclerosisArticularsurfacesubsidence RA CharacterizedbyaninflammatorysynovitisandapotentialtodestroyboneandcartilageMostlyseeninmiddle agedwomanSymmetricdistributionRF Radiologichallmarks ExtensiveanddiffusesynovialhyperplasiaandinflammationSynovialpannusformationMarkedenhancementSeriousarticularcartilagedegeneration Grade or LocalmarginalerosionsObviouslocalosteoporosisJointspacenarrowinginearlystage evenfusion PVNS CharacterizedbysynovialproliferationandhemosiderindepositionintothesynovialtissuesoftheaffectedjointMenaged20 40yearsoldMostlyseeninkneeandanklejointProliferation villous nodular mixed Nodularvarietycommonlyseeninthetendonsheaths principallyonthevolaraspectofthephalanges Radiologichallmarks VariableextentofsynovialproliferationJointeffusionanderosionofboneDepositofhemosiderinwithinthesynovialmassesLowsignalonbothT1WIandT2WIBestseenonFFEsequence Treatment ColchicineNotanaccuratetooltodiagnosegout psoriaticarthritis pseudogout ColdapplicationsAusefuladjuvanttreatment RA Conclusion Plainradiographsarelesssensitivetoearlychangesinchronicgoutthanotherimagingtechniques CTmaybethemostspecificimagingtechniquewhenevaluatingintraosseouslesions whileMRIcouldbethepreferredtechniquetoevaluatechronicsynovialinvolvement Thepresenceofstructuralchangesinradiographscorrelateswithpoorfunction andisassociatedwithirreversibilityofchanges 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