双源能谱CT混合能量扫描及重建对痛风结节诊断的临床价值

The Clinical Value of Dual-Source Spectrum CT Hybrid Energy Scanning and Reconstruction in the Diagnosis of Tophus

目的探讨双源能谱CT混合能量扫描及重建对痛风结节诊断的临床价值。方法选取2016年3月至2017年2月收治的疑似痛风结节患者78例,分别采用常规CT扫描和双源能谱CT混合能量扫描及重建。根据美国风湿病协会痛风诊断标准,观察两种方法对痛风结节诊断的灵敏度和特异度,分析双源能谱CT显示的特征。结果双源能谱CT诊断痛风结节的灵敏度、特异度、准确率分别为94.1%(64/68)、80.0%(8/10)、92.3%(72/78),显著高于常规CT的61.8%(42/68)、60.0%(6/10)、61.5%(48/78)(P<0.05)。双源能谱CT混合能量扫描诊断痛风结节阳性66例,结节影钙基图均呈现低密度影,其中关节周围结节影能谱尿酸基图呈现稍高密度影60例,密度影不清楚6例。结合常规能量扫描对痛风结节的X线征象,当患者出现关节面下骨质小囊样改变、穿凿样骨质破坏、软组织偏心性肿胀时,可确诊为痛风结节。结论双源能谱CT混合能量扫描及重建是一种安全有效的痛风结节影像学检查方法,对痛风结节诊断具有重要的临床价值。

Objective To explore the clinical value of dual-source spectrum CT hybrid energy scanning and reconstruction in the diagnosis of tophus. Methods78 cases of patients with suspected tophus were involved in study from March 2016 to February 2017. According to the American rheumatism association gout diagnostic criteria, we observed the sensitivity and specific degree of the two methods to tophus diagnosis, and analyzed tophus features showed by dual-source spectrum CT. ResultsThe sensitivity, specific degree and accurate rate of the double-source spectrum CT to detect tophus were 94.1% （64/68）, 80.0% （8/10）, and 92.3% （72/78）, and those of conventional CT were 61.76% （42/68）, 60.00% （6/10）, and 61.54% （48/78）; The sensitivity, specific degree and accurate rate of double-source spectrum CT were significantly higher than those of conventional CT （P〈0.05）; Double-source spectrum CT hybrid energy scan in the diagnosis of tophus found 66 positive cases, and showed nodular shadows calcium base figure with low density shadow, including 60 cases of nodular shadows around joints spectrum uric acid base figure with slightly high density shadow and 6 cases of figure with unknown density shadow. In combination with conventional energy scanning X-ray signs of tophus, when patients appeared bone utricle change under the joint surface, create sample bone destruction and eccentric swelling of soft tissue, tophus can be diagnosed. ConclusionThe dual-source spectrum CT hybrid energy scanning and reconstruction in the diagnosis of tophus is a safe and effective imaging method, with important clinical value.