Objective To assess magneric resonance(MR) image features in differentiating tuberculous arthritis from pyogenic arthritis. Methods Findings in 19 patients with tuberculous arthritis were compared with those of 13 patients with pyogenie arthritis. Bone erosion, marrow signal intensity, synovial leasion signal intensity, boundaries for extraarticular extension of infection,and abscess rim enhancement were analyzed, all the cases were form our hospital. Results Bone erosion was more common in patients with tuberculous arthritis [ 16 ( 84 ％ ) of 19] than in those with pyogenic arthritis [6 (46 ％ ) of 13], while subchondral marrow signal intensity abnormality was seen more frequently in patients with pyogenic arthritis [12 ( 92％ ) of 13] than in those with tuberculous arthritis [8 (42％)of 19] . On T2-weighted images, there was no significant difference between the synovial lesion signal intensities of tuberculous arthirtis and pyogenic arthritis. Lesions in 13 (81％) of 16 patients with tuberculous arthirtis and 2 ( 18％ ) of 11 patients with pyogenic arthritis had smooth extraarticular boundaries . Tuberculous abscesses [ 11 (100％)of 11 ] had thin and smooth rim enhancement,whicle most pyogenic abscesses [ 5 (83％)of 6] had thick and irregular rims. Conclusion MR imaging of bone abnormalities, extraarticular lesions, and associated abscesses provides useful information in the differentiation of tuberculous arthritis and pyogenic arthritis.%目的 探讨结核性及化脓性膝关节炎MRI鉴别诊断价值.方法 收集本院经临床证实的结核性膝关节炎19例及化脓性膝关节炎13例,对比分析其MRI表现,主要观察骨质改变、滑膜病变、关节外软组织表现、及脓肿壁形态.结果 结核性膝关节炎关节骨质破坏较化脓性关节炎常见,分别为16例(84%)、6例(46%);关节骨髓水肿则化脓性膝关节炎12例(92%)较结核性膝关节炎8例(42%)常见.T2加权滑膜信号强度在结核性膝关节炎与化脓性膝关节炎时没有明显差异.增强扫描关节周围软组织受累的患者中,19例结核性膝关节炎中13例边界较清楚(81%),13例化脓性关节炎中仅2例边界较清楚(18%).11例形成关节周围脓肿患者中11例脓肿壁均薄而光滑(100%),6例形成关节周围脓肿化脓性关节炎中仅1例脓肿壁薄而光滑(17%).结论 膝关节骨质改变、关节周围软组织病变、脓肿的特点对化脓性膝关节炎及结核性膝关节炎的鉴别诊断有重要价值.
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