双源CT痛风识别技术在检测尿酸盐沉积中的应用

The value of using dual-energy CT in the detection of monosodium urate crystals in patients with gout

目的评价双能量CT（DECT）痛风识别技术在检测痛风患者尿酸盐结晶沉积中的应用。方法回顾性分析108例近2周发作过单关节肿和（或）痛患者的患肢关节双能量CT扫描资料，其中符合美国风湿病学会（ACR）1977年分类标准的痛风患者95例，非痛风组13例。95例痛风患者双能量CT扫描后得到的双能0．3比例融合图像组作为常规组；所获得的80kV及140kV图像输入痛风识别软件，后处理获得的伪彩图像组作为后处理组。观察常规组与后处理组发现的尿酸盐结晶，并采用χ2检验比较；比较两组发现尿酸盐结晶的敏感度和准确率，并采用χ2检验进行比较。结果常规组中有51例患者能显示软组织内尿酸盐结晶，显示病灶的部位共298处；13例非痛风患者中有2例显示高密度结晶；常规组发现尿酸盐结晶的敏感度为53．7％，特异度为84．6％，准确率为57．4％。后处理组中69例患者发现散在的绿色的尿酸盐结晶，显示病灶的部位共401处；13例非痛风患者均未显示绿色的尿酸盐结晶；后处理组发现尿酸盐结晶的敏感度为72．6％，特异性为100．0％，准确率为75．9％。两组发现尿酸盐结晶的病灶数差异有统计学意义（χ2=5．193，P〈0．05），发现尿酸盐结晶的敏感度和准确率差异也有统计学意义（χ2值分别为7．329和8．333，P值均〈0．05）。结论DECT痛风识别技术能发现更多部位、更小体积的尿酸盐结晶，在痛风早期诊断、监测治疗疗效中有潜能。

Objective To evaluate the clinical value of dual-energy CT in the detection of monosodium urate crystals in patients with gout. Methods One hundred and eight patients who experienced unilateral arthrocele and （or） joint pain in the past two weeks were enrolled into our study. DECT were performed for the upper or lower extremity. Ninety-five patients were enrolled into the gout study group based on the American rheumatism association （ACR） classification standard;The 0. 3 linear blended images group were regarded as conventional CT group, DE （80 kV and 140 kV） datasets were reconstructed via gout- recognition software, the pseudo-color images group as the postprocessed group. Imagings were reviewed independently by two senior radiologists. Chi-square test were used for statistical analysis with the SPSS 13.0 software. Results In the conventional CT group, DECT scans revealed a total of 298 areas of urate deposition in 51 patients ; The sensitivity, specificity, and accuracy were 53.7 %, 84. 6% , and 57. 4%. In the postprocessed group, 401 areas of green urate deposition were detected in 69 patients, the sensitivity, specificity, and accuracy were 72.6%, 100.0%, 75.9% respectively, the differences had statistical significance （ χ2 = 7. 329 and 8. 333, P 〈 0. 05 ）. Conclusions DECT gout recognition technology can detect smaller amount of monosodium urate in the other parts of the body, with a great potential in early diagnosis and treatment monitoring of patients with gout.