High-frequency Ultrasound And DECT In The Diagnosis Of Acute Gouty Arthritis During First Attack

ObjectiveTo study and compare the application value of high-frequency ultrasound and dual-source CT dual-energy imaging in the first attack of acute gouty arthritis.MethodsA retrospective analysis was performed on 76 patients who visited the doctor for the first time with joint swelling and pain,and were clinically diagnosed as the first attack of acute gouty arthritis.Clinical data such as high-frequency ultrasound and DECT examination results of affected joints were collected.Spearman’s correlation test was used to test the relationship between laboratory inspection indicators and lesions under ultrasound(including punctate strong echo,"double-contour sign",tophi,aggregates,joint cavity effusion,synovial hyperplasia,and synovitis),and the chi-square test was used to analyze the differences in the incidence of positive features between the high-frequency ultrasound and DECT groups.Results1.There were 83 affected joints in the patients,including 37 first metatarsophalangeal joints,31 ankle joints,11 knee joints,2 interphalangeal joints and 2 wrist joints.2.High-frequency ultrasound showed the highest detection rate of joint cavity effusion(62 cases,81.6%),followed by punctate strong echo(34 cases,44.7%),synovial hyperplasia(22 cases,28.9%),"double-contour sign"(21 cases,27.6%),aggregates(14 cases,18.4%),synovitis(13 cases,17.1%),and tophi(6 cases,7.9%).3.The level of hypersensitive C-reactive protein was positively correlated with the positive high-frequency ultrasound indicators of joint effusion(r=0.256,P=0.026);no significant correlation was found between the blood uric acid level and the positive ultrasound indicators such as punctate strong echo,"double-contour sign",tophi,aggregates,total urate crystals,joint cavity effusion,synovial hyperplasia,and synovitis(P>0.05)4.The detection rate of total urate crystals and joint cavity effusionby high-frequency ultrasound at the patient level(73.7%,81.6%)was significantly higher than that of DECT(30.3%,9.2%)(P<0.05);the detection rate of urate crystals and joint cavity effusion by high-frequency ultrasound at the inter-joint level(86.5%,94.6%)was significantly higher than that of DECT(32.4%,2.7%)(P<0,05);the detection rate of urate crystals and joint cavity effusion by high-frequency ultrasound at the ankle joints level(80.6%,74.2%)was significantly higher than that of DECT(29.0%,6.5%)(P<0.05).5.High-frequency ultrasound can detect synovial thickening and blood flow signals,but DECT cannot.DECT detected 5 cases of bone erosion,including 3 cases of interphalangeal joints,1 case of knee joint,and 1 case of ankle joint,while high-frequency ultrasound did not detect them.6.The number of cases of urate crystals detected by DECT and high-frequency ultrasound at the knee joint level(11)is 6 and 2 respectively.ConclusionHigh-frequency ultrasound can truly reflect the extent of joint lesions involved in acute gouty arthritis during first attack,and provide an effective reference for accurate clinical evaluation of the disease.For patients with the first attack of acute gouty arthritis,high-frequency ultrasound can be used as the first choice.The key joints for screening can be the first metatarsophalangeal joint and the joint of the attack.For patients with difficulty in diagnosis,DECT can be an be combined with high-frequency ultrasound.