双源能谱纯化双能CT结合平扫图像对早期痛风诊断性能研究

Diagnostic Performance of Combining Dual Energy CT with Tin Filtration and Non-Contrast CT Image for Early Gout

目的探讨双源能谱纯化双能CT(Dual-Energy CT,DECT)结合平扫CT(Non-Contrast CT,NCCT)对第一跖趾关节受累的早期痛风患者诊断价值。方法回顾性选取2017年2月1日至2021年6月4日疑似早期痛风患者并由2015年ACR/EULAR痛风分类标准进行诊断,且行双源能谱纯化DECT 93名患者(118个第一跖趾关节)入组。两名放射医师独自对入组关节进行DECT及DECT结合NCCT(DECT+NCCT)评估。计算敏感性、特异度及准确性,使用Mc Nemar,stest比较,行受试者工作特征曲线(Receiver Operating Characteristic,ROC)分析。对早期痛风组中真阳性及假阴性病例事后分析。结果118个关节中,83个为早期痛风组,35个为非痛风组。DECT诊断早期痛风的敏感性、特异度及准确性,阅片者1:62.7%、100%、73.7%,阅片者2:60.2%、100%、72.0%;DECT+NCCT敏感性、特异度及准确性,阅片者1:77.1%、97.1%、83.0%,阅片者2:73.5%、97.1%、80.5%。DECT+NCCT的ROC曲线下面积略高于DECT(阅片者1,0.863vs.0.815;阅片者2,0.847 vs.0.785)。早期痛风组内,两种诊断方法真阳性与假阴性病例中血尿酸浓度具有统计学差异。结论双源能谱纯化DECT结合NCCT图像能够提高对第一跖趾关节受累的早期痛风患者的诊断性能。

Objective To investigate the diagnostic value of non-contrast CT(NCCT)imaging combined with dual-energy CT(DECT)with tin filtration in early gout patients with the first metatarsophalangeal(MTP1)joint involvement.Methods A retrospective study of 93 patients(118 first metatarsophalangeal joints)with suspected early gout diagnosed by the 2015 ACR/EULAR gout classification criteria was performed between February 1,2017 and June 4,2021.Two radiologists independently evaluated DECT for all enrolled joints and then combined DECT and NCCT(DECT+NCCT)for gout diagnosis.Sensitivity,specificity,and accuracy were calculated and compared using McNemar’s test,and receiver operating characteristic(ROC)analysis was performed for the two groups.True positive and false negative cases in the early gout group were retrospectively analyzed.Results Of the 118 joints,83 were in the early gout group and 35 were in the non-gout group.The sensitivity,specificity and accuracy of DECT alone in diagnosing early gout were 62.7%,100%and 73.7%for reader 1 and 60.2%,100%and 72.0%for reader 2.The sensitivity,specificity and accuracy of DECT+NCCT were 77.1%,97.1%and 83.0%for reader 1 and 73.5%,97.1%and 80.5%for reader 2,respectively.The area under the ROC curve(AUC)of DECT+NCCT was slightly higher than that of DECT(reader 1,0.863 vs.0.815;reader 2,0.847 vs.0.785).In the early gout group,the difference of serum uric acid concentration between true positive and false negative cases of the two diagnostic methods was statistically significant.Conclusion DECT combined with NCCT images can improve the diagnostic performance of patients with early gout involving the first metatarsophalangeal joint.