双能量CT对痛风的诊断价值

The value of dual energy computed tomography for the diagnosis of gout

目的评价双能量CT对痛风的诊断价值。方法对试验组的25例痛风患者双侧足部、踝关节、膝关节、手部、腕关节及肘关节行双能量CT扫描成像，统计尿酸盐结晶沉积病灶数，对出现临床症状的关节行X线检查。对患者四肢关节进行临床体检，统计临床病灶数目及部位。对照组的20例类风湿关节炎（RA）患者的受累关节及对侧关节行双能量CT扫描成像。同时检测所有患者的血尿酸、血肌酐、总胆固醇及甘油三酯水平。对比2组患者双能量CT检查结果与x线及临床体检之间的差异。统计学处理采用t检验和，检验。结果双能量cT检查中各关节发现病灶的病例数及比例分别为足部及踝关节23例（92％），膝关节17例（68％）、手与腕关节3例（12％）及肘关节1例（4％），足部及踝关节受累患者最多（P〈0．05）。尿酸盐沉积病灶共184处，其中足与踝关节、膝关节、手与腕关节及肘关节的病灶数分别为107处（58．2％）、72处（39．1％）、4处（2．2％）、1处（0．5％），足部及踝关节中尿酸盐沉积病灶数最多（P〈0．01）。临床统计病灶数为64处，仅占双能量CT发现病灶数的34．8％，差异具有统计学意义（P〈0．01）。而x线检查仅6例患者发现骨质破坏等非特异性改变。试验组患者血尿酸、血肌酐及甘油三酯水平较对照组明显增高，差异具有统计学意义（P值分别为〈0．01，〈0．05，〈0．05）。结论双能量CT对痛风的诊断有重要的临床价值。

Objective To evaluate the value of dual energy computed tomography （DECT） for the diagnosis of gout. Methods Twentyfive consecutive patients with gout were selected as the experimental group and 20 patients with rheumatoid arthritis （RA） were selected as the control group. DECT scans were performed for evelT patient （all peripheral joints for the experimental group and affected joints for the control group）. And every patient with gout had Xray examination of the involved joints. X^2 test and t-test were used for statistical analysis. Results All 25 patients with gout showed urate deposits on their DECT scans, whereas none of 20 controls showed urate deposits （P〈0.01）. DECT scans revealed a total of 184 areas of urate deposition in 25 patients, in which 107 （58.2%） were at feet and ankle, 72 （39.1%） were at knees, 4 （2.2%） were at hands and wrists, 1 （0.5%） was at elbows, whereas physical examination only showed 64 areas of urate deposition, in which 38（59.4%） were at feet and ankle,24（37.5%） were at knees, 2（3.1%） at hands and wrists, 0 was at elbows（P〈0.01 ）. Only 6 patients with gout showed nonspecific manifestations on X-ray. Conclusion DECT scans may have potential value for the diagnosis of gout since it could produce evident colour displays for urate deposits and help to identify subclinical tophus deposits.