单纯螺旋CT平扫在上尿路结石成分判断中的应用  

Application of spiral CT flat scanning on chemical composition judgment of upper urinary calculi

作　　者：范永毅[1] 

机构地区：[1]广西医科大学第四附属医院,广西柳州545005

出　　处：《山东医药》2010年第22期6-7,共2页Shandong Medical Journal

基　　金：柳州市科技局科研基金资助项目(2008031417)

摘　　要：目的观察单纯螺旋CT平扫在上尿路结石化学成分判断中的应用效果。方法 123枚上尿路结石,其中尿酸结石23枚、草酸钙结石41枚、磷酸钙结石10枚、碳酸钙结石8枚、草酸钙磷酸钙混合结石8例、草酸钙尿酸混合结石16例、磷酸钙尿酸结石11例、碳酸钙尿酸结石3例、草酸钙碳酸钙结石3例。采用十六排螺旋CT在患者术前行单纯平扫,参数120 kV/240 mA,螺距0.75∶1,层厚3 mm,测量结石软组织窗平均CT值。结果 82例纯结石平均CT值由高到低依次是磷酸钙(1 276.70±242.40)HU、草酸钙(1 168.71±220.73)HU、碳酸钙(703.38±129.49)HU、尿酸(535.74±172.54)HU。草酸钙与磷酸钙结石CT值相比P>0.05,其余各类纯结石两两比较P均<0.05。非纯尿酸结石CT值为(911.50±163.52)HU,与纯尿酸结石相比P<0.05。CT值<700 HU者纯尿酸结石21例、非纯尿酸结石4例,CT值≥700 HU者纯尿酸结石2例、非纯尿酸结石96例。CT值<700 HU诊断纯尿酸结石灵敏度为91.3%、特异度为96.0%、阳性预测值为84.0%、阴性预测值为98.0%。结论单纯螺旋CT平扫用于判断上尿路结石成分效果满意。根据软组织窗CT值不同,可将体内尿酸结石与其它成分结石区分。软组织窗平均CT值<700 HU的结石可作为纯尿酸结石的诊断标准。Objective To investigate the application value of spiral CT flat scanning on chemical composition judgment of upper urinary calculi. Methods 123 urinary calculi （23 uric acid calcull,41 calcium oxalate calculi, 10 calcium phosphate calculi ,8 calcium carbonate calculi ,8 calcium oxalate and calcium phosphate calculi, 16 calcium oxalate and uric acid calculi, 11 calcium phosphate and uric acid calculi ,3 calcium carbonate and uric acid calculi ,3 calcium carbonate and calcium oxalate calculi ） were visualized with spiral CT fiat scanning at 120 kV, 240 mA, and 0.75：1 pitch, with collimation varying 3 mm. The average CT attenuation value of calculi in soft-tissue window was calculated. Results The average CT value of the 82 pure calculi were （ 1 276.70 ± 242.40） HU for calcium phosphate, （ 1 168.71 ± 220.73 ） HU for calcium oxalate, （703.38 ± 229.49） HU for calcium carbonate, （ 535.74 ± 172.54） HU for uric acid. Except calcium phosphate and calcium oxalate,there were significant differences between the average CT values of each type of pure stone（ P 〈 0.01 ）. The average CT value of calculi except pure uric acid calculi was （922.5 ± 163.52） HU , it was significant different with pure pure acid calculi （ P 〈 0.01 ）. The sensitivity of CT value 〈 700 HU for upper urinary calculi judgment was 91.3% ,the specificity was 96.0% ,the positive predictive value was 84.0% ,the negative predictive value was 98.0%. Conclusion All urinary calculi examined were clearly visible on spiral CT flat scanning. We can differentiatiate pure uric acid ealeulis with other calculis by average CT-attenuation value in soft-window. An average CT value in soft-tissue window of urinary calculi lower than 700 HU was highly suggestive of a pure uric acid calculi.

关 键 词：尿路结石 尿酸 草酸钙 磷酸钙 碳酸钙 计算机体层摄影 CT值 

分 类 号：R692[医药卫生—泌尿科学]