| [Objective]1.To analyze the manifestations of Gemstone spectral CT in the first metatarsophalangeal joint of patients with gout in different periods(asymptomatic hyperuricemia,acute gouty arthritis,chronic gout),to find out different imaging manifestations,to identify different imaging findings and to carry out a comparative study of the groups.2.To compare the age and blood uric acid value of each group,to compare the concentration of uric acid in the first metatarsophalangeal joint bone cortex,cancellous bone and periarticular soft tissue of each group,and to judge the concentration of uric acid in each group.To understand the distribution of uric acid deposits in different tissues.3.To analysis of correlation between serum uric acid value and deposition concentration of different groups of uric acid.To understand the effect of serum uric acid value on the distribution of uric acid deposition.4.To evaluate curative effect in patients with chronic gout before and after treatment.[Methods]84 patients with hyperuricemia who were performed foot Gemstone spectral CT inour hospital from October 2016 to June 2017.Divided into three groups,36 patients(group A)with normal imaging,23 patients(group B)with bone destruction,25patients(group C)with bone destruction and uric acid crystallization.Compare their differences in age and serum uric acid values in the three groups.Through Gemstone spectral CT scanning,the basal concentration of uric acid(calcium)in the first metatarsophalangeal joint bone cortex,cancellous bone and periarticular soft tissue were measured in three groups.And to compare their differences.Correlation of serum uric acid levels with the first metatarsophalangeal joint bone cortex,cancellous bone and periarticular soft tissue uric acid(calcium)in all hyperuricemia patients by linear regression.To analyze and compare the concentration of uric acid deposition,the total volume of uric acid crystal and the maximum individual volume of uric acid crystal before and after treatment in 2 patients with chronic gout.[Results]1.Crystal deposits of uric acid show high concentration on Gemstone spectral CT uric acid(calcium)based material map,and erode to adjacent bone.The calcium(uric acid)based material map shows a low concentration zone,and a clear sclerosing zone at the edge of the eroded bone.On the basis of uric acid(calcium)based material map,the distribution of uric acid crystal deposition can be visualized by using pseudo-color to label the high uric acid concentration region.Gemstone spectral CT can display the concentration of uric acid(calcium),the total volume of uric acid crystal and the maximum individual volume of uric acid crystal.2.There were statistically differences in age,serum uric acid value and the concentration of uric acid(calcium)in periarticular soft tissues of the first metatarsophalangeal joints(P < 0.05).And there were no statistically differences between the concentration of uric acid(calcium)in the first metatarsophalangeal joint bone cortex and cancellous bone.Age: group A(489.5±90.6),group B(48.5±13.9),group C(43.2±12.5);Serum uric acid value: group A(489.5±90.6)?mol/l,group B(494.7±77.2)?mol/l,group C(581.3±69.2)?mol/l;The first metatarsophalangeal joint soft tissue uric acid(ca)concentrations : group A(1169.58±7.88)mg/cm~3,group B(1193.13±16.35)mg/cm~3,group C(1308.20±85.89)mg/cm~3;The first metatarsophalangeal joint bone cortex uric acid(ca)concentration: group A(1324.8±31.4)mg/cm~3,group B(1335.6±37.3)mg/cm~3,group C(1320.4±43.5)mg/cm~3;The first metatarsophalangeal joint cancellous bone uric acid(ca)concentration : group A(1134.3±13.3)mg/cm~3,group B(1145.8 ± 23.3)mg/cm~3,group C(1145.8± 30.9)mg/cm~3.3.The serum uric acid value was linearly positive with the concentration of uric acid(calcium)in soft tissue of the first metatarsal joint,and no correlation with the concentration of uric acid(calcium)in bone cortex,cancellous bone of the first metatarsophalangeal joint.4.In 2 patients with chronic gout after standardized treatment,the concentration of uric acid(calcium)decreased slightly,the total volume of uric acid crystal decreased,and the individual volume of maximum uric acid crystal decreased.The concentration of uric acid(Ca)in 2 patients with chronic gout before treatment were 1340.3 mg / cm~3 and1360.5 mg / cm~3,the results after treatment were 1318.6 mg / cm~3 and 1348.8 mg / cm~3.The total volume of uric acid crystal in foot and ankle before treatment were 23.93cm~3 and 30.56 cm~3,the results after treatment were 21.56 cm~3 and 29.46 cm~3.The maximal volume of uric acid crystals before treatment were 11.65cm~3 and 22.71cm~3,the results after treatment were 11.16cm~3?20.26cm~3.[Conclusion]1.The based material map of gemstone spectral CT can provide more image information for the imaging performance of gout patients.It has a unique advantage in quantitative measurement of the concentration of intra and inside and outside of the joint,and the determination of urate deposition in different tissues,thus better assisting clinical judgment.2.The concentration of uric acid(calcium)in the soft tissue adjacent to the first metatarsophalangeal joint with gout patirnts can reflect the level of uric acid around the joint more sensitively.3.Patients with hyperuricemia after 40 years of age are more likely to have imaging abnormalities.4.The serum uric acid level is correlated with uric acid(calcium)concentration in the soft tissue adjacent to the first metatarsophalangeal joint in patients with gout,That is,the higher the uric acid level in blood,the higher the uric acid(calcium)concentration in the soft tissue adjacent to the first metatarsophalangeal joint.5.For patients with chronic gout,we can monitor the concentration of uric acid deposition and measure the change of uric acid crystal volume and the individual volume change of maximum uric acid crystal after regular treatment,which can provide more important basis for clinical evaluation of curative effect and assessment of disease condition. |
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