双能光子CT对痛风诊断的应用价值

Diagnostic value of dual-energy photons CT in gout

目的探讨双能光子CT在痛风评估中的价值。方法回顾性分析临床确诊为痛风患者111例,其中男105例,女6例。行双能量CT扫描获得CT原始图像和GOUT后处理图像,采用配对设计秩和检验统计法分析CT原始图像和GOUT后处理图像显示的尿酸盐结晶数目。对双能CT测得尿酸盐结晶数目与患者的病程和血尿酸水平分别行Spearman秩相关分析。结果51例(45.95%)位于足部,其中30例(27.03%)累及第一跖趾关节;41例(36.94%)位于膝关节,12例(10.81%)位于踝关节,4例(3.60%)位于手部,2例(1.80%)位于腕部,1例(0.90%)位于腰椎。CT原始图像39例(35.14%)未见异常密度结节,25例(22.52%)见单发高密度结节,47例(42.34%)见多发高密度结节;后处理图像45例(40.54%)见单发尿酸盐结节,66例(59.46%)见多发尿酸盐结节。15例(13.51%)CT原始图像和后处理图像发现结节数目一致,96例(86.49%)后处理图像发现结节多于CT原始图像。CT原始图像和后处理图像发现结节数目差异有统计学意义(Z=-8.522,P<0.001)。病例组病程3 d~30年,血尿酸水平319~800μmol/L,双能CT测得尿酸盐结晶数目与病程和血尿酸水平均为中度正相关(r_s分别为0.465,0.433,P均<0.001)。结论双能光子CT对于痛风患者尿酸盐结晶有较高检出率,对于疑似痛风患者行双能CT检查有助于痛风的确诊。

Objective To explore the diagnostic value of dual-energy photons CT in gout.Methods The clinical data of 111 confirmed gout cases were retrospectively analyzed,including 105 males and 6 females.The original CT and GOUT reconstruction images were acquired from dual-energy photons CT scan.In the two kinds of images,the numbers of urate crystals displayed were analyzed with Wilcoxon Matched-Pairs Signed-Ranks Test.The number of urate crystals displayed in GOUT reconstruction images,course of disease,and serum urate level were analyzed with Spearman rank correlation.Results Gout was detected in the feet in 51 cases(45.95%),in the first metatarsophalangeal joints in 30 cases(27.03%),in the knees in 41 cases(36.94%),in the ankles in 12 cases(10.81%),in the hands in 4 cases(3.60%),in the wrists in 2 cases(1.80%),and in the lumber vertebra in 1 case(0.90%).In the original CT images,no abnormal-density nodules were observed in 39 patients(35.14%);single and multiple high-density nodules were observed in 25(22.52%)and 47(42.34%)cases,respectively.In the reconstruction images,single and multiple urate crystals were observed in 45(40.54%)and 66(59.46%)cases,respectively;15 cases(13.51%)had the same number of urate crystals as in the original images;96 cases(86.49%)displayed more urate crystals than in the original images.There was statistically significant difference in the number of urate crystals displayed between original and reconstruction images(Z=-8.522,P<0.001).The course of disease ranged from 3 days to 3 years and level of serum urate ranged from 319 to 800μmol/L.The number of urate crystals displayed in GOUT reconstruction images was significantly correlated with the course of disease and level of serum urate(r_(s)=0.465,0.433,P<0.001).Conclusion Dual-energy photons CT has a high detection rate of urate crystals,which is helpful in the diagnosis of suspected gout patients.