双能源CT在高原地区检测痛风患者尿酸盐沉积检测中的应用

Application of dual energy CT in detectingurate deposition in gout patients at high altitude

目的 探讨双能CT对高原地区关节痛风尿酸盐结晶形成中的应用价值。方法 收集2021年6月~2022年5月在本院确诊为通风性关节炎患者20例。按检查方法分为手检组(20例,由1名多年临床经验的风湿科医生对患者进行查体并记录尿酸盐结晶沉积节的数目和形态)和CT组(20例,由1名多年放射诊断经验的医生在双能CT重建后的关节图像观察并记录有无尿酸盐结晶沉积,结晶的位置、数目、形态等),并进行统计分析。结果 20例痛风患者,平均血尿酸量为(439.15±150.36)μmol/L,血清尿酸超过360μmol/L者占75.0%。尿酸盐结晶沉积常见部位膝关节、足关节和腕关节为主,其次为肘关节;膝关节主要分布在前后交叉韧带、内外侧副韧带、髌上囊、髌韧带,足踝部以第一跖趾关节、踝关节距腓韧带、跟腱及手腕关节背侧肌腱深处为主。双源CT发现516处尿酸盐结晶,临床体格检查发现结晶为195处,两者比较差异有统计学意义(p<0.05)。结论 双源CT双能量成像技术具有简便、无创优势,可清晰显示关节隐蔽部位的尿酸盐结晶,优于临床体格检查,可用于高原地区痛风性关节患者评估中。

Objective To explore the application value of dual-energy CT in the formation of urate crystals in joint gout in pla-teau area.Methods 20 patients with ventilated arthritis diagnosed in our hospital from June 2021 to May 2022 were collected.Ac-cording to the examination methods,the patients were divided into medical examination group(20 cases,a rheumatologist with many years of clinical experience examined the patients and recorded the number and morphology of urate crystal deposition seg-ments)and CT group(20 cases,a doctor with many years of experience in radiological diagnosis observed and recorded the pres-ence or absence of urate crystal deposition,location,number and morphology of crystals,etc.)in the joint image after dual-energy CT reconstruction,and statistical analysis was performed.Results the average blood uric acid content of 20 patients with gout was(439.15±150.36)μmol/L,and 75.0%of the patients had serum uric acid higher than 360μmol/L.The common deposition sites of urate crystals were knee joint,foot joint and wrist joint,followed by elbow joint.The knee joint is mainly distributed in the anterior and posterior cruciate ligaments,medial and lateral collateral ligaments,suprapatellar bursa,and patellar ligament.The foot and an-kle are mainly the first metatarsophalangeal joint,ankle talofibular ligament,Achilles tendon and wrist joint dorsal tendon.Dual source CT found 516 urate crystals,clinical physical examination found 195 crystals,the difference was statistically significant(p<0.05).Conclusion Dual-source CT dual-energy imaging technology has the advantages of simplicity and non-invasiveness.It can clearly show the urate crystals in the hidden parts of the joints.It is superior to clinical physical examination and can be used for the evaluation of patients with gouty joints in the plateau area.