频发型与偶发型痛风足踝部MRI影像表现的差异性研究

Comparative Study of MRI Imaging Features in Frequent Gout Flares and Infrequent Gout Flares of the Foot and Ankle

摘要: 目的：通过磁共振成像(MRI)对频发型与偶发型痛风足踝部影像学征象进行定量及半定量评估，探究两种类型痛风MRI影像表现的差异性，为痛风分型提供影像学依据。材料与方法：前瞻性收集MRI组78例，频发型54例，偶发型痛风24例。收集患者临床及影像学资料，进行统计学分析，采用二分类logistic回归分析痛风频发的独立危险因素，并绘制受试者工作曲线(ROC)。结果：频发型痛风在病程、BMI、收缩压/舒张压这些指标上均高于偶发型痛风。MRI影像表现中频发型痛风在痛风石发生率、痛风石总分、骨侵蚀总分、骨髓水肿总分、肌腱韧带病变总分、软组织肿胀率、滑膜增厚率、骨质增生硬化率及关节间隙变窄率均大于偶发型痛风(p < 0.05)；并且得到痛风石总分、骨侵蚀总分、肌腱韧带病变总分高是频发型痛风的独立危险因素(p < 0.05)，以上述三因素联合共同识别频发型痛风的AUC为0.936 (95% CI 0.882~0.990)，其敏感度为92.6%、特异度为83.3%。结论：相较于偶发型痛风，频发型痛风MRI影像学表现为痛风石累及范围更广、骨侵蚀程度更严重、肌腱韧带病变更严重。对痛风患者分型及精准治疗提供影像学理论依据。

Abstract: Objective: To quantitatively and semi-quantitatively evaluate MRI features of frequent gout flares (FrGF) and infrequent gout flares (InGF) in the foot and ankle, and to investigate the differences in MRI manifestations between these two types of gout, thereby providing imaging evidence for gout classification. Materials and Methods: This prospective study included 78 gout patients who underwent MRI examination (54 FrGF, 24 InGF). Clinical and imaging data were collected and statistically analyzed. Binary logistic regression was used to identify independent risk factors for frequent gout flares, and receiver operating characteristic (ROC) curves were plotted. Results: Patients with FrGF had significantly longer disease duration, higher BMI, and elevated systolic/diastolic blood pressure compared to InGF (p < 0.05). MRI findings showed that FrGF had a higher tophus occurrence rate, tophus scores, bone erosion scores, bone marrow edema scores, tendon/ligament lesion scores, as well as higher rates of soft tissue swelling, synovial thickening, osteosclerosis, and joint space narrowing than InGF (p < 0.05). High tophus score, bone erosion score, and tendon/ligament score are independent risk factors for FrGF (p < 0.05). The combination of these three factors achieved an AUC of 0.936 (95% CI 0.882~0.990) for identifying FrGF, with sensitivity of 92.6% and specificity of 83.3%. Conclusion: Compared to InGF, FrGF demonstrates more extensive tophus involvement, more severe bone erosion, and worse tendon/ligament damage on MRI. These findings provide imaging evidence for gout classification and precise treatment.