双能CT成像技术检测尿酸盐结晶对痛风诊断的临床价值研究  

Detection of monosodium urate crystals with dual-energy CT in gout patients

作　　者：唐栋[1] 王晓嫚[2] 戚乐[1] 王冬梅[1] Tang Dong;Wang Xiaoman;Qi Le;Wang Dongmei(Department of Radiology,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;Department of Sonography,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院放射科,310015 [2]杭州师范大学附属医院超声科,310015

出　　处：《中华全科医师杂志》2019年第1期52-56,共5页Chinese Journal of General Practitioners

基　　金：浙江省中医药科技计划青年人才基金项目(2015ZQ018).

摘　　要：目的了解双能CT(DECT)成像技术在痛风尿酸盐结晶检测中的应用价值。方法回顾性分析2014年1月至2017年9月在杭州师范大学附属医院住院101例疑似痛风患者的影像及临床资料,其中临床诊断为痛风者64例(痛风组)、未诊断为痛风者37例(非痛风组)。比较两组患者性别、血尿酸水平、CT剂量、检查部位数及DECT对痛风结晶石诊断的灵敏度、特异度、假阳性、假阴性及阳性预测值、阴性预测值;构建受试者工作特征(ROC)曲线并计算ROC曲线下面积。结果痛风组64例,共检测85处关节;非痛风组37例,共检测42处关节;两组间性别(χ2=5.32,P=0.03)、血尿酸水平(t=1.95,P=0.04)差异均有统计学意义;DECT对痛风结晶石灵敏度0.844(54/64)、特异度0.703(26/37),假阳性率29.7%(11/37),假阴性率15.6%(10/64),阳性预测值83.1%,阴性预测值72.2%,痛风组尿酸盐结晶阳性率高于非痛风组,差异有统计学意义(χ2=30.52,P<0.001);ROC曲线下面积为0.74,标准误为0.05,95%CI为0.64~0.85。结论DECT技术对尿酸盐结晶检测及诊断具有较高灵敏度、特异度和可靠性,可清楚显示结晶沉积及范围、骨质破坏情况,有效地评估及监测痛风病情。Objective To evaluate the application of the dual-energy CT (DECT) in detection of monosodium urate (MSU) crystals in gout patients.Methods The imaging and clinical data of 101 patients with suspected gout were retrospectively analyzed, including 64 cases of clinically diagnosed gout (gout group) and 37 non-gout cases (non-gout group). The DECT examination was performed for 85 joints in gout group and 42 joints in non-joint group. The value of DECT in detection of MSU crystals was evaluated with receiver operating characteristic (ROC) curve.Results There were significant differences in gender (χ2=5.32, P=0.03) and blood uric acid levels (t=1.95, P=0.04) between gout and non-gout groups. The detection rate of MSU in gout group was significantly higher than that of non-gout group (χ2=30.52, P<0.001). The area under the ROC curve (AUC) of DECT in detection of was 0.74±0.05 (Mean±SE), 95%CI:0.64-0.85. The sensitivity, specificity, positive predictive value and negative predictive value of the DECT in detection of gouty stone was 0.844, 0.703, 83.1% and 72.2%, respectively.Conclusion The dual-energy CT has high sensitivity, specificity and reliability for the detection and diagnosis of monosodium urate crystals in joints of gout patients.

关 键 词：放射摄影术 能扫描投影 痛风 关节炎 痛风性 结晶 尿酸 

分 类 号：R589.7[医药卫生—内分泌]