Angio Plus Plan Wave Ultransensitive Imaging (AP),Color Power Doppler Imaging (CPI) And High Frequency Ultrasound (HFUS) In The Diagnosis And Curative Effect Evaluation Of Gouty Arthritis

Objective:We use high frequency ultrasound(HFUS)to detect crystalline strong echo and synovial hyperplasia in the articular cavity,cartilage and bone surface and surrounding soft tissue of patients with gouty arthritis(GA);and the semi-quantitatively graded by using Angio plusplanwave ultransensitive imaging(AP)and color power Doppler imaging(CPI)to explore the application of CPI、AP technology and HFUS in the diagnosis and evaluation of gouty arthritis.Methods:A total of 40 GA patients with 98 joint were selected for ultrasound examination of joints from December 2018 to December 2019in our hospital.There were 37 males and 3 females,aged from 22 to 85years old,with an average age of(45.33±14.32)years.The course of disease ranged from 1 to 33 years,with an average of(5.88±6.12)years.Bilateral ankle joint,metatarsophalangeal joint,knee joint and so on were explored in each patient,and the more serious lesions were selected to observe whether synovial hyperplasia and intraarticular effusion,articular bone destruction and specific signs(blizzard sign,double-contour sign,gout stone)existed,and compared with the detection rate of gout by dual-energy computed tomography(DECT)was observed.At the same time,the thickest part of synovial hyperplasia was selected as the measuring section,and the display of synovial blood flow was observed by color Doppler flow imaging(CDFI),and the image parameters were adjusted to clear display.Then CPI and AP techniques were used to observe and record the synovial blood flow,and graded according to the semi-quantitatively classification standard.At the same time,the sites with synovial blood flow signals were examined again by ultrasound at 1 month,3 months and 6 months after treatment,and AP technique was used for semi-quantitative classification.SPSS26.0 statistical software was used to compare the detection rate of crystal by HFUS and DECT and synovial blood flow by CPI and AP.Chi-square test was carried out on the results of CPI and AP classification.Then the correlation between the blood flow classification results of CPI and AP and the statistical data of laboratory indexes(ESR,CRP,UA)were analyzed,and the correlation coefficient r was used to express the correlation of the data.The synovial blood flow grades before treatment,1month,3 months and 6 months after treatment were tested by chi-square test,and the P<0.05 was taken as the statistically significant standard.Results:1.A total of 98 joints in 40 patients with GA were examined by high frequency ultrasound.There were 27 cases of gouty stone,72 cases of double-contour sign,35 cases of blizzard sign,67 cases of synovial hyperplasia,82 cases of articular effusion and 9 cases of bone destruction.2.A total of 98 joints of 40 patients with GA were examined for urate crystals by HFUS and DECT.Among them,the detection rate of high frequency ultrasound was 77.5%,and the detection rate of DECT was87.7%.There was no significant difference between the two groups(χ~2=2.901,P=0.089).3.Compared with the display rate of synovial blood flow of CPI and AP technology,the display rate of synovial blood flow of CPI was 65.6%.The display rate of synovial blood flow of CPI was 74.6%,and the difference was statistically significant(χ~2=43.579,P<0.05).4.There was significant difference between CPI and AP in the classification of synovial blood flow signals(χ~2=87.127,P<0.05).5.The correlation coefficients between CPI and laboratory indexes were r(UA)=0.591,r(CRP)=0.546,r(ESR)=0.597,and the correlation coefficients between AP and laboratory indexes were r(UA)=0.696,r (CRP)=0.638,r(ESR)=0.692.The grade of synovial blood flow by CPI and AP techniques was positively correlated with laboratory indexes.6.AP technique was used to monitor 67 synovial hyperplasia joints.The synovial blood flow was monitored before treatment,1 month,3months and 6 months after treatment.And semi-quantitative was carried out.The number of joints in grade 0 was 17,17,20,25;and the number of joints in grade 1 was 9,11,18,22;and the number of joints in grade 2was19,21,17,11;and the number of joints in grade 3 was 22,18,12,9.The semi-quantitative classification of synovial blood flow by AP technique could monitor the changes of synovial blood flow,and the difference was statistically significant(χ~2=37.106,P<0.05).Conclusion:HFUS is consistent with DECT in detecting the crystal deposition in the articular cavity of patients with GA,and can observe synovial hyperplasia and effusion in the articular cavity.The changes of ultrasonic manifestations are consistent with the changes of patients before and after treatment and clinical signs,and both AP and CPI can detect synovial blood flow in patients with GA,which is positively correlated with laboratory indexes,but AP has a higher detection rate of synovial blood flow than CPI,and has a higher correlation with laboratory indexes,so AP can be used as a new ultrasonic diagnostic technique to detect and evaluate synovial blood flow signals in patients with gout.The purpose of this study is to monitor the progress of its activity and inflammation,so as to provide reference for evaluating the clinical treatment effect and making further treatment plan.