DECT在早期痛风尿酸盐结晶检测中的应用价值

The Value of DECT in the Detection of Urate Crystals in Early Stage of Gout

目的探讨双源CT双能量成像(DECT)技术在四肢关节早期痛风尿酸盐结晶检测中的作用和价值。方法回顾性研究搜集到的按照美国风湿病学会(ACR)1977年分类标准确诊为早期痛风的85例患者的临床资料,设为病例组,对照组为25例因临床需要行四肢关节检查的非痛风患者,比较两组在尿酸盐结晶检出率、沉积部位、大小及形态等方面的差异。结果在85例早期痛风组中,74例(急性痛风性关节炎期69例,痛风无症状期5例)检测出绿色尿酸盐结晶,总共563处,第一跖趾关节周围是最易沉积的部位,对照组均未检出尿酸盐结晶;两组在尿酸盐结晶检出率方面的差异具有统计学意义。DECT对早期痛风组检测的敏感性为87.06%(74/85),特异性为100%,假阳性率为0,假阴性率为12.94%(11/85)。结论 DECT能够检测出位置深、体积小、数量少的尿酸盐晶体,并能测量晶体大小,检测病情变化,对早期痛风尿酸盐结晶的检出率很高,在早期痛风的诊治及鉴别等方面具有很大的应用价值和潜能。

Objective To evaluate the dual energy CT imaging technology（DECT） role and value for early detection of gout urate crystals.Methods A retrospective study was done on 85 patients with gout,in accordance with American College of Rheumatology（ACR） 1977 classification criteria for early diagnosis of gout.The control group was made of 25 nongout patients who needed to perform clinical examinations of limbs and joints for other reasons,the difference between the two groups in the detection rate of urate crystals deposition location,size and shape was performed.Results among 85 cases of early gout,green urate crystals were detected in 74 patients（69 cases presented with acute gouty arthritis and 5cases with asymptomatic gout）,a total of 563 zones.The deposition around the first metatarsophalangeal joint was the most higher.No urate crystals were detected in the control group.the two groups showed significant statistical difference in terms of the detection rate of urate crystals.DECT sensitivity of detection of early gout group was（74/85） 87.06% and the specificity was 100%,false positive rate was 0,false negative rate was（11/85） 12.94%.Conclusion DECT can detect the location of deep,small and minimal amount of urate crystals,helping to identify the crystal size and the changes in condition;meaning that it is a great value and potential in the detection and differentiation of early gout.