单源能谱CT对急性痛风性关节炎的诊断价值及对尿酸盐沉积特点的分析

The Diagnostic Value of Single-source Dual-energy CT in Patients with Acute Gouty Arthritis

目的:评价单源能谱CT对急性痛风病人的诊断价值,分析尿酸盐沉积特点及其与痛风性关节炎急性发作的相关性。方法:63例近期发生过关节肿胀或者关节痛的患者(其中痛风患者51例,其他关节病变患者12例)使用单源能谱CT进行扫描,观察扫描部位有无尿酸盐结晶沉积,计算尿酸盐结晶的数量,分布,体积,有效原子序数。分析尿酸盐结晶沉积的特点及其与痛风性关节炎急性发作的的相关性。结果:51例急性痛风患者中,有49例检测出尿酸盐结晶存在,12例其他关节病变的患者中,有2例检测出尿酸盐结晶存在。敏感性,特异性,阳性预测值,阴性预测值分别为:96.1%,83.3%,96.1%,83.3%。尿酸盐结晶体积为9.8±6.1ml(0.1ml-56ml)。有效原子序数7.36±0.4(7.19-7.82)。尿酸盐结晶的数量,体积与急性痛风的发作正相关(r=0.660,p=0.031;r=0.792,p=0.024),而尿酸盐结晶的有效原子序数与急性痛风的发作均无明显的相关性(r=0.260,p=0.331)。结论:单源能谱CT可以清晰显示急性痛风的尿酸盐结晶沉积,其特异性、敏感性较高。患者尿酸盐结晶沉积的数量及体积与痛风急性发作有较高的相关性。

Objective： To evaluate the diagnostic value of single - source dual - energy （SSDE） CT for acute gout patients and analyze the monosodium urate crystals （MUGs） sedimentary characteristics as well as its correlation with the onset of acute gouty arthritis. Methods： 63 patients with recent joint swelling or joint pain were enrolled into this study （51 cases were gout patients and 12 cases were patients with other joint disease）. All the patients underwent a SSDE CT scan with gout mode, to observe the presence of MUGs deposition and calculate the amount, volume, distribution and effective atomic number of MUCs. Then, the spearmen analysis was used to analyze correlations between correlation MUGs sedimentary characteristics and the onset of acute gouty arthritis. Result： of 51 patients with acute gout, MUGs were detected in 49 patients; of 12 pa- tients with other joint disease, MUGs were detected in 2 cases. The sensitivity, specificity, positive predictive value and nega- tive predictive value were： 96. 1%, 83.3%, 96. 1% and 83.3%, respectively. The average volume of MUCs was 9. 8 ＋ 6. lml （0. lml -56ml）, the effective atomic number of MUCs was 7. 36 ＋ 0. 4 （7. 19 - 7.82）. The amount and the vol- ume of MUCs were associated with the onset of acute gouty arthritis （r = 0.660, p = 0.031; r = 0.792, p = 0.024, re- spectively）, while the effective atomic number of MUCs has little correlation with the onset of acute gouty arthritis （ r = 0. 260, p = 0. 331 ）. Conclusion： The SSDE CT with gout mode could detect MUCs deposition with high specificity and sensi- tivity in patients with acute gouty arthritis. The amount and the volume of MUGs derived from SSDE CT images were associated with the onset of acute gouty arthritis.