足踝双源CT伪影识别对痛风诊断的临床价值

Clinical value of artifact identification in ankle dual-energy CT for gout diagnosis

目的研究足踝双源CT检查中伪影识别对痛风诊断的临床价值。方法收集2018年12月至2019年5月于北京大学第三医院临床诊断为痛风患者58例为病例组,男57例、女1例,年龄18~69(39±13)岁。对照组收集同期因运动损伤来诊,明确排除痛风患者37例,男36例、女1例,年龄为16~76(34±14)岁。两组均行单侧足踝部双源CT扫描,病例组选取患侧/症状重侧。并利用痛风软件(Dual-Energy Gout)对所得薄层数据进行尿酸盐分析。比较两组在趾甲、亚毫米点、皮肤、运动影及血管钙化影等影像中检出尿酸盐阳性的差异。应用SPSS 22.0统计软件,采用独立样本t检验、非参数Kruskal-Wallis秩和检验对结果进行统计学分析。结果病例组与对照组阳性趾甲检出率分别为94.8%(55/58)和59.5%(22/37),单个个体阳性趾甲检出个数及阳性趾甲尿酸盐分布差异均有统计学意义(均P<0.01)。病例组与对照组伪彩阳性亚毫米点总检出率分别为81.0%(47/58)和13.5%(5/37),在肌腱韧带的检出率分别为75.9%(44/58)和13.5%(5/37),差异均有统计学意义(均P<0.01)。两组数据在皮肤、运动影及血管钙化影伪彩阳性的检出率方面差异均无统计学意义。结论趾甲与亚毫米点尿酸盐伪彩阳性对痛风诊断具有较高的临床价值,不应被简单判定为伪影。

Objective To investigate the clinical value of artifact identification in ankle dual-energy CT for gout diagnosis.Methods A total of 58 patients with gout,who were definitely diagnosed in Peking University Third Hospital from December 2018 to May 2019,were included in the case group,which were composed of 57 males and 1 female.And 37 individuals without gout were regarded as control group,which were composed of 36 males and 1 female.Dual-energy CT was performed for one foot,and the affected side or the more serious side was chosen in the case group.The dual-energy data were used in gout-recognition software to highlight the monosodium urate(MSU)with green-colored.And to compare the difference in MSU relevance ratio on the images of toenail,submillimeter spots,skins,movements and vascular calcification between two groups.Results In the case group,55 patients were revealed with MSU green-colored toenails(relevance ratio 94.8%),while 22 cases in the control groups(relevance ratio 59.5%).There was significantly statistical difference on the mean toenails numbers and the MSU distribution scores in the two groups(all P<0.01).In the case group,47 patients were revealed with green-colored submillimeter spots(relevance ratio 81.0%),while 5 cases in the control group(relevance ratio 13.5%).The relevance ratio of submillimeter spots on tendon and ligament in the case group and control group were 75.9%(44/58)and 13.5%(5/37).There was also significantly statistical difference in the two groups on submillimeter spots(all P<0.01).And there was no significantly statistical difference in the two groups on MSU green-colored skins,movements and vascular calcification.Conclusion There is great value for gout clinical diagnosis when green-colored MSU is detected on toenails and submillimeter spots,which should not be judged as artifact simply.