基于双源双能CT区分体内上尿路不同类型钙结石

In Vivo Characterization of Sub-differentiation of Upper Urinary Calcium Calculi on Dual-Source Dual-Energy CT

目的探讨双源双能CT区分体内上尿路不同类型钙结石的临床价值。方法共55枚钙结石纳入研究,结石离体前均行双源双能CT检查,以红外光谱分析结果作为金标准,分为4组：组1（一水草酸钙,12）,组2（一水草酸钙＋二水草酸钙,9）,组3（一水草酸钙＋碳酸磷灰石,8）,组4（一水草酸钙＋二水草酸钙＋碳酸磷灰石,26）,最后将组1、组2、组3融合为新的一组,为混合钙结石组。通过获得的多个双能量参数,对不同类型的钙结石进行分析。结果 （1）4组结石的双能比、双能量指数均有统计学差异,而4组结石的双能差则无统计学差异。两两比较时,组1、组2和组4三组之间的双能比差异均具有统计学意义;组4与组1、组2、组3的DEI比较差异均具有统计学意义;只有组3和组4的双能差有统计学差异;其余各组结石间差异均无统计学意义。（2）一水草酸钙组的双能比、DEI均低于混合钙结石组,其中,双能比的诊断效能较好,其ROC分析一水草酸钙的曲线下面积为0.822,截取值为1.40。结论双源DECT成像技术获得的多个参数有助于区别体内不同类型的钙结石,尤其是对碎石抵抗的一水草酸钙,在术前评估中具有重要价值。

Objective To explore the clinical value of DECT in assessing the sub-differentiation of upper urinary calcium calculi in vivo. Methods The study total included 55 calcium calculi,all underwent DECT examination in vivo,the result of infrared spectrometer as the gold standard,which were divided into four groups： group 1（ COM,12）,group 2（ COM＋ COD,9）,group 3（ COM ＋ CaP,8）,group 4（ COM ＋ COD ＋ CaP,26）,then combined group 2,group 3 and group 4,named mixed calcium calculi group. We used multiple parameters of DECT to analyze subdifferentiation of calcium calculi.Results（ 1） The parameters of DE ratios,DEI measured by four groups all had statistical significance,while the attenuation differences had no statistical significance. DE ratios were significantly different between group 1,group 2 and group 4.DEI of group 4 with group 1,group 2,group 3 did differ significantly. Attenuation differences can only distinguish between group3 and group 4. There were no significant difference in other groups.（ 2） The COM group had significantly lower DE and DEI ratios compared with mixed calcium calculi group,ROC analysis for detection of COM calculi yielded AUC of0. 803 with cut-off DE ratio 1. 40. Conclusion The multiple parameters obtained by dual source DECT provide new ideal and new method,which can help to differentiation of various types of calcium calculi and for detection of relatively lithotripsy-resistant COM calculi,has important significance in the preoperative assessment.