Musculoskeletal Ultrasound Studies In Establishing The Diagnosis Of Gout And Clinical Application

PartⅠ Research on musculoskeletal ultrasound in diagnosis of goutObjective:Evaluate the performance and the diagnostic value of the musculoskeletal ultrasound(MSUS) in gout patients.Methods:There are 77 gout patients,all the patients meet 1997 ACR gout classification criteria.They visit to Shanxi Dayi hospital during June 2015 to December 2015. 54 cases are controls(21 RA, 24 OA, 9 AS). Collect all the clinical datas and laboratory examination,rheumatologists examin the signs of the joint.MSUS check two sides of the knees, ankles and first metatarsophalangeal joints,two independent rheumatologists reading the image. Obser of the following five indicators: ⑴ double-track sign ⑵ crystalline aggregates(intra-articular hyperechoic cloud area, heterogeneous strong echo with acoustic shadow behind, hyperechoic tendon point) ⑶ joint effusion ⑷ synovial hyperplasia ⑸ bone erosion.Calculation the sensitive and specific of DCS, crystalline aggregates. Drawing ROC curve,evaluate the MSUS detecting MSU with 1997 ACR criteria for the diagnosis of gout.Results:1.gout specific signs There are 77 patients in gout group, a total of 462 joints, 54 patients in the control group, a total of 324 joints. Observe five indicators were statistically significant(P <0.05)⑴ DCS(17.1%) ⑵ crystalline aggregates(13.9%) ⑶ joint effusion(9.3%) ⑷ synovial hyperplasia(9.5%) ⑸ bone erosion(5.0%).2.MSUS value of the diagnosis of gout64 patients(131) can see DCS and/or crystalline aggregates, 63 patients can not see these asymptoms.DCS and/or crystalline aggregates appear on any one or more than one overall sensitivity and specificity for the diagnosis of gout are 57/77(74.0%), 47/54(87.04%),respectively.3.MSUS detection of urate crystals diagnose gout and 1997 ACR criteria for the diagnosis of gout gout consistency and accuracy of the assessment Kappa- consistency test, the consistency of the two methods showed a moderate level(Κ = 0.589, P <0.001). The area under the ROC curve was 0.805, indicating that the diagnostic value MSUS medium, has a certain diagnostic value.4.MSUS detection of urate crystals diagnostic gold standard for diagnosis of gout and gout consistency and accuracy of the assessment Kappa- consistency test, the consistency of the two methods is poor(Κ = 0.085, P =0.715). The area under the ROC curve was 0.538, indicating that the diagnostic value MSUS medium, has a certain diagnostic value.Conclusion:The sensitivity and specificity of MSUS to diagnosis Gout are high.it can be used to differ gouts from other arthritis.PartⅡ Comparison the diagnostic value of musculoskeletal and DECT for gouty arthritisObjective:Compare the diagnostic value for detecting monosodium urate crystal deposits between dual-energy CT(DECT) and Musculoskeletal Ultrasound(MSUS)in gouty patients.Methods:Seventy-third consecutive patients(70 men, mean age 41 years) who meet the 1997 ACR gouty arthritis classification criteria were included in this study.MSUS assessment and diagnosis of gout DECT consistency. Statistics gout patients in the first attack and the entire course of the disease most likely involved joint case, further bilateral easily affected joints simultaneously MSUS examination and DECT, compare the two methods of urate crystals difference detection rate.Results:Both MSUS and DECT can find MSU deposition in gout patients.Kappa consistency test, the consistency of the two methods was statistically significant difference(P <0.001), Κ= 0.025, the consistency of the two methods is poor.Patients whenever they are,first attack or all the disease process, easily affected joints are the MTP1,knee,ankle(P ﹤ 0.001). MTP1 s simultaneously take MSUS and DECT, there is no difference in the detection rate of urate crystals(p=1.000), Knees,ankles simultaneously take MSUS and DECT, DECT urate crystal detection rate higher than MSUS(p﹤0.001)Conclusion:Both MSUS and DECT can be used for the diagnosis of gout, two methods have advantages and disadvantages, DECT can show deeper urate crystal deposition, but the presence of radiation. MSUS can be used for the initial screening of gout, suspected gout patients,unless there are no MSU,people can go on DECT,thus improve the accuracy of diagnosis of gout.