痛风尿酸盐结晶在膝关节分布特征的观察与分析:一项基于双源CT双能量成像的初步研究

Observation and Analysis of the Distribution Characteristics of the Urate Crystals in Gouty Knee Arthritis: A Preliminary Study Based on Dual-source CT Dual-energy Imaging Abstract

目的基于双源CT双能量成像技术,观察痛风尿酸盐结晶在膝关节分布特征;分析尿酸盐结晶总体积、数目与血尿酸水平的相关性;对照分析CT平扫与双能量成像检测痛风石的阳性率;统计受检者受到的有效辐射剂量(ED)。方法搜集28例痛风患者行双侧膝关节双能量CT扫描并同步搜集患者血尿酸数据。根据尿酸盐结晶沉积部位不同分为肌腱韧带部位、半月板部位和其他部位,分别进行记录和统计。比较左、右膝关节尿酸盐结晶体积、数目之间的差异。并对每例尿酸盐结晶总体积、数目与血尿酸水平进行相关性分析。比较CT平扫与双能量成像检测膝关节痛风石的阳性率;同时,记录每例患者接受的辐射剂量。结果28例患者中双能量CT发现27例有尿酸盐结晶沉积,双侧膝关节共观察到232处沉积点,左、右膝关节尿酸盐结晶沉积点数目占比分别为42.7%(99/232)和57.3%(133/232)。累及肌腱韧带最常见部位为股四头肌肌腱、前交叉韧带和腘肌肌腱,占比分别为16.8%(39/232)、12.5%(29/232)和9.9%(23/232);累及半月板最常见部位为外侧半月板,占比为10.8%(25/232);少见部位如髌股间隙,占比为4.3%(10/232)。另外发现,尿酸盐结晶沉积总体积为0.01~85.95 cm^3,平均(3.83±16.44)cm^3,左、右膝关节尿酸盐结晶沉积体积范围分别为0.00~42.14 cm^3,平均(1.93±8.38 cm^3)、0.01~43.81 cm^3,平均(2.21±8.70)cm^3,右膝关节尿酸盐结晶沉积体积显著高于左膝关节(P=0.043)。血尿酸水平为184~652μmol/L,平均(483.3±129.1)μmol/L;尿酸盐结晶总体积、数目与血尿酸水平之间差异无统计学意义(P=0.530,P=0.254);CT平扫检测左、右膝关节痛风石例数占比分别为54.6%(15/28)和60.7%(17/28),双能量成像检测左、右膝关节痛风石数目占比分别为82.1%(23/28)和96.4%(27/28),两种检查方法对痛风石检出有显著差异(卡方值=14.75,P<0.001);每例患者接受ED为0.056~0.084 mSv,平均(0.070±0.008)mSv。结论膝关节痛风尿酸盐结晶最常见沉积部位为股四头肌肌腱、前交叉韧带和外侧半月板;右膝关节尿酸盐结晶沉积体积较大、数目较多;尿酸盐结晶总体积与血尿酸水平无相关;双能量成像较CT平扫检测痛风石阳性率高;膝关节双能量CT扫描辐射剂量低。

Objective To observe the distribution characteristics of the urate crystals in patients with gouty knee arthri-tis based on dual-energy CT.To analyze the relationships between the total volume of urate crystals and the number of urate crystals with the level of blood uric acid,and to investigate the effective radiation doses received by patients.To compare the difference in detection rate of the urate crystals between conventional CT and dual-energy CT.Methods The dual-en-ergy CT data and clinical data of 28 patients with gouty knee arthritis were retrospectively analyzed.All the CT data were grouped and compared statistically,according to the different diposition sites of urate crystals.The relationships between the total volume of uric acid crystals and the number of uric acid crystals with the level of uric acid in blood were analyzed.The difference in detection rate of the urate crystals between conventional CT and dual-energy CT was compared.The radia-tion dose received by each patient was also recorded.Results Among the 28 patients,27 of them were found to have u-rate crystal deposition by dual-energy CT.A total of 232 urate crystal deposition points were observed at the bilateral knee joint.The number of urate crystal deposition points at the left and right knee joint accounted for 42.7%(99/232)and 57.3%(133/232),respectively.The obvious deposition sites for the urate crystals were the quadriceps femoris tendon,ante-rior cruciate ligament and popliteal tendon,accounting for 16.8%(39/232),12.5%(29/232)and 9.9%(23/232),respectively.The most common site in the meniscii was the lateral meniscus,accounting for 10.8%(25/232).Rare sites such as patellofemoral space accounted for 4.3%(10/232)were also observed.In addition,the total volume of the urate crystal deposition was found to range from 0.01 cm3 to 85.95 cm3(3.83±16.44)cm3,and the urate crystal deposition vol-ume was different between the left and right knee joints(1.93±8.38 cm3 vs.2.21±8.70 cm3).The level of serum u-ric acid ranged from 184μmol/L to 652μmol/L(483.3±129.1)μmol/L.There was statistical difference in the detec-tion rate of the urate crystals between conventional CT and dual-energy CT(Chi-squared value=14.75,P<0.001).There was no statistical correlation between the total volumes and numbers with the level of uric acid in the blood.The effective radiation dose received by each patient ranged from 0.056 mSv to 0.084 mSv(0.070±0.008)mSv.Conclusion The common deposition sites of the urate crystals in gouty knee arthritis are the quadriceps femoris tendon,the anterior cruciate ligament and the lateral meniscus.The volume and number of urate crystals are larger in the right knee joint.The total vol-ume and number of the urate crystals are not correlated with the level of blood uric acid in patients with gouty knee arthritis.Dual-energy CT has a higher detection rate of the urate crystals.The radiation dose of dual-energy CT scanning of the knee joint is lower.