单源能谱CT混合能量扫描及重建对痛风结节诊断的临床价值

Clinical value of single-source spectrum CT mixed energy scanning and reconstruction in diagnosis of tophus

目的探讨单源能谱CT混合能量扫描及重建对痛风结节诊断的临床价值。方法回顾分析我院收治的疑似痛风患者72例,进行单源能谱CT(Discovery CT750 HD)混合能量扫描,并对尿酸基图和钙基图进行分拆重建,并结合常规能量扫描图进行诊断。根据美国风湿病协会痛风诊断标准,观察单源能谱CT混合能量扫描及重建对痛风结节诊断的特异性和敏感性,并分析此方法影像学显示的特征。结果单源能谱CT混合能量扫描及重建对痛风结节诊断的敏感性为93.7%(59/63)、特异性为77.8%(7/9)、准确率为91.7%(66/72)。单源能谱CT混合能量扫描诊断阳性61例患者,结节影钙基图上均呈低密度影;其中,57例关节周围结节影能谱尿酸基图显示稍高密度影,4例显示不清楚。结合其常规能量扫描对痛风结节的X线征象,包括关节面下骨质小囊样改变及穿凿样骨质破坏,软组织偏心性肿胀,均可明确痛风诊断。结论单源能谱CT混合能量扫描及重建对痛风结节的诊断具有重要的临床价值,是一种简单,安全,廉价的影像检查方法,可广泛应用于痛风的健康体检和疾病筛查。

Objective To discuss the clinical value of single-source spectrum CT mixed energy scanning and reconstruction in diagnosis of tophus. Methods 72 patients with suspected gout were reviewed. Single-source spectrum CT（Discovery CT750 HD） mixed energy scanning was conducted, and the uric acid-based imaging and the calcium-based imaging were reconstructed. Diagnosis was made in combination with routine energy scanning. Based on the American College of Rheumatology diagnostic criteria for gout, the specificity and sensitivity of single-source spectrum CT mixed energy scanning and reconstruction in diagnosis of tophus were observed, and the features of this imaging method were analyzed. Results The sensitivity of single-source spectrum CT mixed energy scanning and reconstruction in diagnosis of tophus was 93.7%（59/63）, the specificity was 77.8%（7/9）, and the accuracy rate was 91.7%（66/72）. 61 patients were diagnosed as positive by the single-source spectrum CT mixed energy scanning, and the shadow of tophus was low-density in the calcium-based imaging; of which 57 cases were slightly high-density in the uric acid-based imaging,and 4 cases were not clear. Combined with the X-ray features by other routine energy scanning, including subchondral bone follicle-like changes and penetrating bone destruction, and soft tissue decentered swelling, the diagnosis could be confirmed. Conclusion Single-source spectrum CT mixed energy scanning and reconstruction has important clinical value in diagnosis of tophus, which is a convenient, safe, and low-cost method of imaging examination and can be widely used in physical examination and screening of gout.