肌骨超声联合CT能谱成像在痛风性关节炎中的诊断价值

Diagnostic Value of Musculoskeletal Ultrasonography Combined With Energy Spectrum CT in Gouty Arthritis

目的探讨肌骨超声联合CT能谱成像在痛风性关节炎中的临床诊断价值。方法选取2019年1月—2020年12月在收治于惠州市第三人民医院的临床症状高度疑似痛风性关节炎患者60例作为研究对象,系统对比单独肌骨超声、单独CT能谱成像以及肌骨超声联合CT能谱成像三者在晶体沉积、骨侵蚀以及血流信号等指标的差异。其次,以关节穿刺和镜检尿酸单钠晶体(monosodium urate,MSU)为“金标准”,系统评估肌骨超声联合CT能谱成像检查的敏感度、特异性、阳性预测值以及阴性预测值等诊断效能指标,以期系统评估肌骨超声联合CT能谱成像检查对痛风性关节炎患者早期诊断的临床应用潜力。结果(1)肌骨超声联合CT能谱成像对晶体沉积以及骨侵蚀的检出率显著高于单独肌骨超声以及单独CT能谱成像,差异有统计学意义(P<0.05);(2)以关节穿刺和镜检尿酸单钠晶体(MSU)为“金标准”,肌骨超声联合CT能谱成像诊断痛风性关节炎的100%(55/55)、特异性为80.0%(4/5),阳性预测值为98.2%(55/56),阴性预测值为100%(4/4)。结论对于痛风性关节炎的早期诊断,肌骨超声联合CT能谱成像检查比单一检查手段具有更高的诊断效能,可为痛风性关节炎的早期诊断及临床诊疗提供理论指导及参考借鉴。

Objective To explore the clinical diagnostic value of musculoskeletal ultrasound combined with CT energy spectrum imaging in gouty arthritis.Methods A total of 60 patients with suspected gouty arthritis who were admitted to the Huizhou Third People’s Hospital from January 2019 to December 2020 were selected as the research subjects.The differences in crystal deposition,bone erosion,and blood flow signals were systematically compared between musculoskeletal ultrasound alone,CT spectrum imaging alone,and musculoskeletal ultrasound combined with CT spectrum imaging.Secondly,with joint puncture and microscopic examination of monosodium urate(MSU)as the“gold standard”,the diagnostic efficacy index including sensitivity,specificity,positive predictive value and negative predictive value of musculoskeletal ultrasound combined with CT spectroscopy were systematically evaluated,in order to systematically evaluate the clinical application potential of musculoskeletal ultrasonography combined with CT spectral imaging in the early diagnosis of gouty arthritis patients.Results(1)The detection rate of musculoskeletal ultrasound combined with CT energy spectrum imaging for crystal deposition and bone erosion was significantly higher than that of musculoskeletal ultrasound and CT energy spectrum imaging alone,and the difference was statistically significant(P<0.05).(2)Arthrocentesis and microscopic examination of monosodium urate crystals(MSU)were the“gold standard”,musculoskeletal ultrasonography combined with computed tomography spectral imaging was 100%(55/55)and specificity was 80.0%(4/5)in the diagnosis of gouty arthritis,the positive predictive value was 98.2%(55/56),and the negative predictive value was 100%(4/4).Conclusion For the early diagnosis of gouty arthritis,musculoskeletal ultrasound combined with CT energy spectrum imaging has a higher diagnostic efficiency than a single examination method,which can provide theoretical guidance and reference for the early diagnosis and clinical treatment of gouty arthritis.