Современные методы визуализации подагрических тофусов

Цель исследования: представить роль обзорной рентгенографии, ультразвуковое исследование (УЗИ), магнитно-резонансной томографии (МРТ), рутинной и двухэнергетической компьютерной томографии (ДЭКТ), а также остеосцинтиграфии в диагностике подагрического артрита. 

Материал и методы. Анализ литературных источников выполнялся в информационно-аналитических системах PubMed и Google Scholar за 2012–2023 гг. с использованием следующих ключевых слов: подагрический артрит, подагрический тофус, imaging of gout, X-ray study, ultrasound, CT, dual-energy CT, MRI, bone scintigraphy, PET/CT.

Результаты. Проанализировано 894 статьи, 39 из которых использованы для составления обзора. Дополнительно использованы 42 статьи за 2018–2023 гг. и клинические рекомендации. Результаты поиска: статьи сгруппированы в блоки на основании лучевых модальностей, систематизирована визуальная картина и роль каждой модальности в ранней диагностике подагрического артрита.

Заключение. Несмотря на то что “золотым стандартом” диагностики подагрического артрита является исследование синовиальной жидкости, основная роль в выявлении данного заболевания отводится лучевой диагностике.

Современные диагностические модальности – УЗИ, МРТ и ДЭКТ открывают новые возможности в выявлении подагры без необходимости инвазивной процедуры пункции сустава. Наибольшей диагностической информативностью обладают УЗИ и ДЭКТ, включенные в классификационные критерии ACR и EULAR.

ДЭКТ опережает в сравнительном аспекте другие лучевые модальности, при этом обеспечивает визуализацию кристаллов Моноурата натрия и их количественную оценку.

Результаты исследований, оценивающих чувствительность и специфичность современных методов визуализации, позволяют говорить о возможности адекватной и своевременной диагностике подагры. В то же время необходимо учитывать проблемы и ограничения используемых диагностических модальностей, что создают основу для дальнейших исследований в этом направлении.

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