目的 分析痛风结节的CT和MRI表现,探讨其特征性影像表现.方法 对23例临床确诊为痛风性关节炎的病人的病变关节行CT和MR检查,CT检查14个膝关节,26个踝关节,MR检查6个膝关节,15个踝关节.将痛风结节分为骨内组、邻骨组和骨外组,总结其影像学特征.结果 CT共显示104个痛风结节,MR显示47个.骨内组15个,11个分布于关节骨端周缘,7个表现为分叶状,9个结节内显示砂石样高密度,12个边缘显示翘起的薄如蛋壳样骨皮质,MR上7个周围显示骨髓水肿信号;邻骨组86个,69个分布于韧带和(或)肌腱上,30个表现为条块状,36个结节内显示砂石样高密度,26个相邻骨质显示弧形骨质破环.MR上22个痛风结节为长T1短T2信号,在脂肪抑制T2WI上为混杂信号,21个周围显示骨髓水肿信号,31个显示周围软组织水肿;骨外组3个.结论 痛风结节好发于韧带和肌腱,多呈条块状并邻骨质生长,周围骨质多显示弧形和波浪状骨质破坏,内多显示砂石样高密度,周围常显示骨髓水肿信号和软组织水肿.%Objective To explore CT and MR imaging findings of tophus. Methods 23 patients with gouty arthritis proved clinically underwent C T ( 14 knee joints and 26 ankle joints) and MRI ( 6 knee joints and 15 ankle joints) examinations. All the tophus were divided into three groups: intraosscous tophus, juxta-osscous tophus, cxtraosscous tophus. CT and MR imaging findings were analysed. Results CT showed 104 tophus and MR demonstrated 17 tophus totally. 15 intraosscous tophi were found by CT and MR imaging, in which 11 deposited in bone edge of joints, 7 showed lobulatcd outline and 9 manifested sandy high density area, while 12 cases had tilted eggshell-like cortical bone, and 7 showed bone marrow edema around the tophi by MR imaging. There were 86 juxta-osscous tophus, of them, 69 deposited in ligaments and/or tendons, 30 displayed strip contour and 36 showed sandy high dense arc-a, 26 associated with curved osseous defects. On MRI, 22 tophi demonstrated low signal intensity on both T1 WI and T2WI, mixed signal intensity on fat-suppressed T2WI; in addition, bone marrow edema signal intensity and soft tissue edema could be seen in 21 and 31 cases respectively. The number of cxtraosscous tophi was 3. Conclusion The tophi usually deposit in ligaments and/or tendons and adjacent to bone with curved osseous defect. They also showed strip appearance ,sandy high density area, bone marrow edema signal intensity and soft tissue edema.
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