| Objective:Objective to explore the potential of musculoskeletal ultrasound(MSUs)in the differential diagnosis of gouty arthritis in different periods.On the basis of conventional ultrasound(US),shear wave elastography(SWE)combined with plane wave hypersensitive blood flow imaging(AP)was used to provide sensitive imaging basis for the diagnosis of gouty arthritis in different periods.Methods:from November 2019 to December 2020,55 patients with gouty arthritis and first metatarsophalangeal joint disease were selected from the Department of Rheumatology,immunology and endocrinology of Qujing Hospital Affiliated to Kunming Medical University.The clinicians diagnosed according to the 2015 gout diagnosis standard and divided into groups according to the 1977 acute gout classification standard.Aixplorer color Doppler ultrasound diagnostic instrument of French acoustic department was used to examine and measure the first metatarsophalangeal joint.L4-115 high frequency linear array probe,SWE software and AP blood flow imaging technology were used in all patients;The musculoskeletal pre-set conditions were selected,and the instrument was adjusted to the best effect of image display.The body position was to let the patients lay their feet flat on the examination table.The same method was used for all subjects,and us,SWE and synovial blood flow examination were performed on the first metatarsophalangeal joint.The general clinical data,maximum modulus of elasticity(Emax),mean modulus of elasticity(emean),blood flow classification under color Doppler flow imaging(CDFI)and AP conditions,as well as dual track sign,echo focus,gout stone and cortical bone erosion under conventional ultrasound conditions were recorded.The blood flow of synovial layer was divided into 0 to 3 grades by semi quantitative ultrasound.The parameters of double track sign and echo focus were classified by qualitative grading method:positive or negative.Spss26.0 software was used for statistical analysis and processing of data results.Results:1.There was no significant difference in gender,age,serum uric acid level,smoking history and drinking history between acute gouty arthritis group and critical gouty arthritis group(P>0.05).2.There was no significant difference in echo focus,double track sign and cortical bone erosion between acute gouty arthritis group and critical gouty arthritis group(P>0.05).The diagnosis of double track sign for gouty arthritis showed diagnostic certainty in this study.In this study,gout stone had significant difference in the staging of acute and chronic gouty arthritis(P<0.05)3.The area under the ROC curve of Emax in predicting acute and critical stages of gouty arthritis was 0.891.The sensitivity and specificity of Emax in predicting stages were 83%and 84%respectively.When the synovial hardness was greater than or equal to 272.25kpa,it was more likely to be the critical stage.When the synovial hardness was less than 272.25kpa,it was more likely to be the acute stage.The area under ROC curve of emean was 0.904.The sensitivity and specificity of emean were 90%and 92%respectively.When the synovial hardness was greater than or equal to 131.05kpa,it was more likely to be a critical period.When the synovial hardness was less than 131.05kpa,it was more likely to be an acute period.The sensitivity and specificity of emean were higher than those of Emax.The area under the curve of Emax and emean was greater than 50%of the preset value,and the difference was statistically significant(P<0.05).Emax and emean can be used in the staging of gouty arthritis,and emean is superior.4.The area under the ROC curve of CDFI was 0.620.The sensitivity and specificity of CDFI were 80%and 40%respectively.When the blood flow grade was greater than or equal to grade 1,it was more likely to be in the acute phase,and when it was less than grade 1,it was more likely to be in the critical phase.The area under the ROC curve of AP was 0.906,and the sensitivity and specificity of AP were 76%and 90%respectively.When the blood flow grade was greater than or equal to grade 2,it was more likely to be in the acute phase,and when the blood flow grade was less than grade 2,it was more likely to be in the critical phase,and the specificity was significantly higher than that of CDFI.The area under the curve of CDFI and AP was greater than 50%of the preset value,and the difference was statistically significant(P<0.05).CDFI and AP are effective in detecting synovial blood flow in acute gouty arthritis,and AP is more accurate.5.In parallel experiment,the sensitivity,specificity and accuracy of swe combined with CDFI were 98%,37%and 78%respectively in acute stage group and critical stage group,and the sensitivity,specificity and accuracy of swe combined with AP were 98%,83%and 96%respectively.The specificity and accuracy of swe combined with AP were higher than that of swe combined with CDFI.The accuracy of swe combined with AP in the staging diagnosis of gouty arthritis was better than swe combined with CDFI under the same experimental conditions,and the difference was statistically significant(P<0.05).Conclusion:Compared with CDFI under normal conditions,CDFI under AP condition is more sensitive to synovial blood flow;Combined use of swe and synovial flow imaging on the basis of conventional us can improve the diagnostic performance of acute gouty arthritis and critical interval gouty arthritis,and the US based swe combined with AP has the best blood flow pattern. |
PDF Full Text Request