双源CT双能量成像对痛风诊断价值的初步研究

Dual-Energy Imaging of Urate Crystals in Gout Using Dual-Source CT

目的探讨双源CT双能量成像(DECT)技术在痛风患者四肢关节尿酸盐结晶的显示能力及其临床应用价值,并就DECT对痛风的疗效进行初步评估。方法病例组为临床确诊为痛风或高尿酸血症患者50例,男46例,女4例,足45例,手5例;对照组为非痛风患者10例,两组性别及年龄比较,差异无统计学意义(P年龄=0.234,P性别=0.612,P>0.05)。分别对其足/手行DECT非增强扫描及薄层重组(0.75 mm),将原始数据输送加载入Du-al-Energy GOUT软件内进行图像后处理,比较病例组和对照组患者尿酸盐沉积的差异以及DECT检测尿酸盐沉积部位与临床评估的差异。采用t检验,Fisher精确概率进行统计学分析。结果病例组均获得了较满意的DECT图像,显示尿酸盐结晶沉积478处,最少2处,最多24处,以足踝部病灶最多;对照组均未见尿酸盐结晶沉积,检出率两组相比,差异有显著统计学意义(P=0.00012,P<0.001)。结论 DECT技术可明确显示尿酸盐结晶沉积,对于关节痛及疑似痛风患者,尤其是痛风早期有较高的检出率。经引导下穿刺抽吸,与CT像一致,具有较高的临床应用价值,可作为痛风筛选的常规检查项目,但就DECT对痛风疗效的评估有待于收集更多的病例进一步研究。

Objective To evaluate the capabilities and efficacy of dual energy CT （DECT） in displaying urate crystals in extremities joints of gout. Methods In study group, 50 clinically confirmed patients （46 males and 4 females） with gout or hyperuricemia were collected. Gout involved feet in 45 cases, hands in 5. In control group, 10 normal volunteers were collected. There was no significant difference between the two groups on age and gender （ P_age = 0. 234, P_gender = 0. 612,P 〉0.05）. DECT noncontrast scanning and thin sliced （0.75 mm） reconstruction of foot / hand were performed.The urate deposition were compared between 2 groups. Results The high quality dual energy images were obtained in all cases. 478 sites of urate crystal deposition were displayed. The diseased sites are most in Feet and ankles were the mostly involved site. There was no nrate crystal deposition found in control group. There was significant difference between two groups on displaying urate crystal（ P = 0. 00012 ,P 〈 0.001 ）. Conclusion Dual source DECT technology can clearly display the urate crystal deposition, which can be used as routine examination for the gout diagnosis.