高频超声与DECT对痛风性关节炎诊断价值的比较

Diagnostic value of high frequency ultrasound and dual-energy CT for gouty arthritis

目的探讨高频超声和双源CT双能量成像(DECT)诊断痛风性关节炎(GA)的价值。方法对33例GA患者(共157个关节)和18例其他关节炎(非GA,共100个关节)患者分别行高频超声和DECT检查,并观察GA患者尿酸盐结晶、骨质缺损、关节积液、滑膜增厚等和病变部位的CDFI表现。结果高频超声诊断GA的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为77.70%、93.00%、83.70%、94.60%、72.70%,与DECT(87.90%、97.00%、91.40%、97.90%、83.60%)相比差异无统计学意义(P均>0.05)。高频超声和DECT诊断GA的曲线下面积分别为0.93和0.85(P<0.05)。两种方法检出尿酸盐结晶、骨质缺损、关节积液的Kappa值分别为0.56、0.74、0.82(P均<0.05)。高频超声检出GA患者22个关节滑膜增厚,DECT检查不能检出滑膜增厚。结论高频超声和DECT均可用于诊断GA;DECT检测尿酸盐结晶较高频超声更有优势。

Objective To compare the value of high frequency ultrasound and DECT in diagnosis of gouty arthritis （GA）. Methods Thirty-three patients with GA （157 joints） and 18 patients without GA （100 joints） were examined with high frequency ultrasound and DECT. The monosodium urate, bone erosion, effusion, synovial thickening of GA were observed with both methods, and the synovial vascularity was observed with CDFI. Results The sensitivity, specificity, accuracy, positive predictive and negative predictive of high frequency ultrasound for diagnosing GA was 77.70%, 93.00%, 83.70%, 94.60% and 72.70%, of DECT was 87.90%, 97.00%, 91.40%, 97.90% and 83.60%, respectively. There was no significant difference between the two methods （all P〉0. 05）. The area under the curves （AUC） of high frequency ultrasound and DECT was 0.93 and 0.85, respectively （P〈0.05）. The Kappa values of the two methods in detecting monosodium urate, bone erosion and effusion were 0.56, 0. 74 and 0. 82, respectively （all P〈0.05）. Synovial thickening of GA were in 22 joints with high frequency ultrasound, while DECT did not find synovial thickening. Conclusion Both high frequency ultrasound and DECT are helpful to diagnosis of GA. DECT has higher value in detecting monosodium urate of GA.