대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제83권5호
  • /
  • Pages.1071-1080
  • /
  • 2022
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

급성 통풍성 슬관절염과 패혈성 슬관절염의 자기공명영상 소견 비교

Comparison of MR Findings between Patients with Septic Arthritis and Acute Gouty Arthritis of the Knee

  • 윤수영 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 추혜정 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 정해웅 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 이선주 (인제대학교 의과대학 부산백병원 영상의학과)
  • Su Young Yun (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Hye Jung Choo (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Hae Woong Jeong (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Sun Joo Lee (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine)
  • 투고 : 2021.08.27
  • 심사 : 2022.02.23
  • 발행 : 2022.09.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적 급성 통풍성 관절염과 패혈성 관절염의 자기공명영상 소견 차이를 알아본다. 대상과 방법 2012년 10월부터 2018년 10월까지 패혈성 혹은 통풍성 관절염으로 확진된 자기공명영상을 촬영한 환자를 대상으로 연구하였다. 패혈성 관절염과 급성 통풍성 관절염의 자기공명영상 소견으로 골수부종, 연부조직 부종, 농양 형성 여부, 활액막 비후 양상(엽상체, 층판, 미만성 선형 모양), 활액막 최대 두께와 관절액 양을 평가하였다. 통풍성 관절염(5명)과 패혈성 관절염(10명)을 윌콕슨 순위합 검정과 피셔 정확 검정으로 비교하였다. 결과 자기공명영상으로 평가된 각 소견은 두 군 사이에 유의한 통계학적 차이는 보이지 않았다. 골수부종은 통풍성 관절염군에서 1건, 패혈성 관절염군에서 7건 관찰되었다. 연부조직 농양은 패혈성 관절염군에서만 관찰되었다. 활액막 비후양상은 통풍성 관절염군은 모두 미만성 선형 모양(100%), 패혈성 관절염군은 엽상체 모양(20%), 층판 모양(50%), 미만성 선형 모양(30%)으로 나타났다. 결론 통풍성 관절염과 패혈성 관절염은 자기공명영상 소견만으로 감별은 어려울 것으로 생각된다. 그러나 층판 모양 활액막 비후나 골수부종, 연부조직 농양의 경우 패혈성 관절염에서 더 흔히 보였다.

Purpose To compare the MR findings of septic and acute gouty arthritis of the knee joint. Materials and Methods This retrospective study included patients who underwent knee MRI for septic or gouty arthritis at our hospital between October 2012 and October 2018. The MR findings were analyzed for the presence of bone marrow edema, soft tissue edema, abscess, pattern of synovial thickening (frondlike, lamellated, diffuse linear), maximum thickness of the synovium, and joint effusion volume. The gouty (n = 5) and septic arthritis (n = 10) groups were compared using the Wilcoxon rank-sum test and Fisher's exact test. Results No statistically significant differences were observed for each item. One patient in the gouty arthritis group and seven in the septic arthritis group had bone marrow edema. Soft tissue abscess formation was only observed in the septic group. The incidence of each synovial thickening pattern was as follows: 100% (diffuse linear) in the gouty arthritis group and 20% (frondlike), 50% (lamellated), and 30% (diffuse linear) in the septic arthritis group. Conclusion Differentiation of gouty arthritis and septic arthritis based on imaging findings is difficult. However, lamellated synovial thickening patterns, bone marrow edema, and soft tissue abscess formation are more commonly observed in patients with septic arthritis than in those with gouty arthritis.

키워드

과제정보

This work was supported by Grant from Inje University, 2019. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

참고문헌

  1. Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA 2007;297:1478-1488 
  2. Rogachefsky RA, Carneiro R, Altman RD, Burkhalter WE. Gout presenting as infectious arthritis. Two case reports. J Bone Joint Surg Am 1994;76:269-273 
  3. Goldenberg DL, Reed JI. Bacterial arthritis. N Engl J Med 1985;312:764-771 
  4. Lee GK, Lee JY, Suh JS, Na JB, Yang I, Kang IW, et al. MR imaging findings of acute gouty arthritis. J Korean Radiol Soc 2006;55:165-171 
  5. Schumacher HR, Chen LX. Chapter 365: gout and other crystal-associated arthropathies. In Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, eds. Harrison's principles of internal medicine. 20th ed. New York: McGraw Hill 2018:1-11 
  6. Gupta MN, Sturrock RD, Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford) 2001;40:24-30 
  7. Swan A, Amer H, Dieppe P. The value of synovial fluid assays in the diagnosis of joint disease: a literature survey. Ann Rheum Dis 2002;61:493-498 
  8. Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann Rheum Dis 1999;58:214-219 
  9. Gupta MN, Sturrock RD, Field M. Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis. Ann Rheum Dis 2003;62:327-331 
  10. Manshady BM, Thompson GR, Weiss JJ. Septic arthritis in a general hospital 1966-1977. J Rheumatol 1980;7:523-530 
  11. Li SF, Henderson J, Dickman E, Darzynkiewicz R. Laboratory tests in adults with monoarticular arthritis: can they rule out a septic joint? Acad Emerg Med 2004;11:276-280 
  12. Ferrand J, El Samad Y, Brunschweiler B, Grados F, Dehamchia-Rehailia N, Sejourne A, et al. Morbimortality in adult patients with septic arthritis: a three-year hospital-based study. BMC Infect Dis 2016;16:239 
  13. Eggebeen AT. Gout: an update. Am Fam Physician 2007;76:801-808 
  14. Li AE, Sneag DB, Greditzer HG 4th, Johnson CC, Miller TT, Potter HG. Total knee arthroplasty: diagnostic accuracy of patterns of synovitis at MR imaging. Radiology 2016;281:499-506 
  15. Graif M, Schweitzer ME, Deely D, Matteucci T. The septic versus nonseptic inflamed joint: MRI characteristics. Skeletal Radiol 1999;28:616-620 
  16. Kwack KS, Cho JH, Lee JH, Cho JH, Oh KK, Kim SY. Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR Am J Roentgenol 2007;189:437-445 
  17. Karchevsky M, Schweitzer ME, Morrison WB, Parellada JA. MRI findings of septic arthritis and associated osteomyelitis in adults. AJR Am J Roentgenol 2004;182:119-122 
  18. Kim EY, Kwack KS, Cho JH, Lee DH, Yoon SH. Usefulness of dynamic contrast-enhanced MRI in differentiating between septic arthritis and transient synovitis in the hip joint. AJR Am J Roentgenol 2012;198:428-433 
  19. Yang WJ, Im SA, Lim GY, Chun HJ, Jung NY, Sung MS, et al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol 2006;36:1154-1158 
  20. Jung MY, Kim HR. Ultrasonographic assessment in crystal-induced arthritis. Korean J Med 2015;89:632-643 
  21. Yu KH, Luo SF, Liou LB, Wu YJ, Tsai WP, Chen JY, et al. Concomitant septic and gouty arthritis--an analysis of 30 cases. Rheumatology (Oxford) 2003;42:1062-1066 
  22. Girish G, Glazebrook KN, Jacobson JA. Advanced imaging in gout. AJR Am J Roentgenol 2013;201:515-525 
  23. Towiwat P, Chhana A, Dalbeth N. The anatomical pathology of gout: a systematic literature review. BMC Musculoskelet Disord 2019;20:140