超声与双能计算机断层扫描评估痛风性膝关节炎的一致性及差异分析

Consistency and difference analysis of ultrasound and dual-energy computed tomography in assessing gouty knee arthritis

目的评估超声与双能计算机断层扫描(DECT)对痛风性关节炎(GA)诊断的一致性并分析差异原因。方法回顾性分析2022年2月至2023年10月在青岛大学附属医院痛风专病门诊确诊的147例痛风患者150个膝关节的超声与DECT图像,根据膝关节解剖分为关节腔内及关节前方、后方、内侧和外侧共五个区域,对尿酸盐晶体(MSU)沉积部位进行细致定位。采用Kappa一致性检验评估膝关节不同区域两种检查结果的一致性,并进一步采用McNemar卡方检验进行DECT与超声结果的差异性分析。结果双轨征(82.1%,92/112)是GA患者最常见的膝关节腔内超声征象,腘肌腱及周围是关节腔外MSU较常见沉积部位(超声:51.6%,66/128;DECT:54.7%,70/128)。超声测及92个显示"双轨征"的膝关节及49个显示聚集体的膝关节中,均仅9个膝关节在DECT图像中发现对应位置的MSU沉积。在评估MSU沉积上,综合考虑聚集体、痛风石、双轨征三种阳性征象,超声总体阳性率高于DECT(87.3%比72.3%,P=0.001),且两种检查一致性较差(Kappa=0.153)。在不同区域:超声与DECT在内侧(Kappa=0.697)及外侧(Kappa=0.718)表现为高度一致性,差异无统计学意义(P>0.05);关节腔内(Kappa=0.289)及关节前侧(Kappa=0.303)一致性一般,诊断差异有统计学意义(P<0.05)。仅评估痛风石征象时,在关节内侧、外侧,超声与DECT表现为高度一致性(Kappa=0.685、0.748),差异无统计学意义(P>0.05);而两种检查在关节腔内一致性较低(Kappa=0.147),差异有统计学意义(P<0.001)。结论超声与DECT对GA均具有良好的诊断能力,但在不同解剖部位一致性不同,临床需要根据解剖位置具体评估。DECT对评估关节腔内MSU沉积有优势,超声对于早期、散在的MSU沉积更敏感。

Objective To assess the consistency of ultrasound and dual-energy computed tomography(DECT)in the diagnosis of gouty arthritis(GA),reasons of the differences were further analyzed.Methods The ultrasound and DECT images of 150 knee joints from 147 patients diagnosed with gout at the Gout Specialty Clinic of Qingdao University Affiliated Hospital from February 2022 to October 2023 were retrospectively analyzed.According to anatomy,the knee joint was anatomically segmented into five regions:intra-articular,anterior,posterior,medial,and lateral.Location of monosodium urate(MSU)deposition was meticulously recorded.The Kappa consistency test was employed to assess the consistency of the two examination results in different regions of the knee joint.The McNemar chi-square test was utilized to conduct a differential analysis between DECT and ultrasound results.Results Double contour sign(DCS)(81.2%,92/112)was the most common intra-articular ultrasound sign in knee joints with GA.In the extra-articular region,MSU was commonly deposited in and around the popliteal tendon(ultrasound:51.6%,66/128;DECT:54.7%,70/128).Corresponding MSU deposits on DECT were found in 9 of 92 joints with DCS and in 9 of 49 joints with aggregates detected on ultrasound.In the assessment of MSU deposits,ultrasound showed an overall higher positive rate than DECT(87.3%vs.72.3%,P=0.001),with poor consistency between the two examinations(Kappa=0.153).In distinct anatomical regions,ultrasound and DECT showed high consistency in the medial(Kappa=0.697)and lateral(Kappa=0.718)sides and the difference was not statistically significant(P>0.05).Intra-articular(Kappa=0.289)and anterior(Kappa=0.303)regions exhibited only fair consistency,with statistically significant diagnostic differences(P<0.05).When exclusively assessing cases with tophus,ultrasound and DECT demonstrated high consistency in the medial and lateral aspects(Kappa=0.685,0.748)without statistical difference(P>0.05).In the anterior region,the consistency between the two examinations was moderate(Kappa=0.256),while in the intra-articular region,the consistency of the two methods was lower(Kappa=0.147),and the differences was statistically significant(P<0.001).Conclusions Both ultrasound and DECT exhibit good diagnostic capabilities for gouty knee arthritis.However,the consistency between the two techniques varies in different anatomical locations.Clinical assessment should be tailored based on the specific anatomical position.DECT has an advantage in evaluating intra-articular MSU deposits,while ultrasound is more sensitive to detect early and scattered MSU deposits.