双源CT预测泌尿系统结石化学成分的临床价值  

Clinical analysis on predictive value of dual-source CT scanning for urinary stone composition

作　　者：黎川[1] 傅强[2] 梁勇[1] 王新[1] 王庆[1] 赵骏[1] 周代全[1] 

机构地区：[1]第三军医大学西南医院放射科,重庆400038 [2]解放军第37医院放射科,四川雅安625000

出　　处：《第三军医大学学报》2015年第6期568-572,共5页Journal of Third Military Medical University

基　　金：重庆市自然科学基金(CSTC2010BB5195)~~

摘　　要：目的评价双源CT双能量扫描体外预测泌尿系统结石成分的准确性。方法对50例泌尿系统结石患者术前行双能量CT扫描,分别测量每枚结石在80 k V和140 k V成像条件下的CT值、CT值差值和CT值比值。使用双能量结石分析软件预测结石成分。收集患者治疗后结石标本行红外光谱仪分析结石成分,作为金标准,运用方差分析比较不同种类结石之间上述指标的差异;评价2种方法检测结果的一致性。结果 50枚结石中尿酸类结石有4枚,非尿酸类结石有46枚(胱氨酸结石5枚,羟基磷灰石2枚,草酸钙结石33枚,混合结石6枚)。组间两两比较,尿酸类结石与其他结石的CT值、CT值差值、CT值比值均有统计学差异(P<0.01);草酸钙结石和混合结石与其他结石的CT值、CT值差值、CT值比值均有统计学差异(P<0.05);其余组间两两比较无统计学差异(P>0.05)。与红外光谱仪分析法结果比较,双能量软件正确诊断4例尿酸类结石、4例胱氨酸结石,33例草酸钙结石、2例尿酸与草酸钙混合结石;另外7例误诊,其中1例胱氨酸结石和2例羟基磷灰石双源CT误诊为草酸钙结石,4例尿酸与羟基磷灰石混合结石双源CT误诊为胱氨酸与羟基磷灰石的混合结石。双能量软件分析结果与红外光谱法分析结果 Kappa一致性检验值为0.705,二者具有高度一致性。结论双源CT双能量扫描能准确区分尿酸类结石、胱氨酸类结石和含钙结石,但在区分含钙结石和羟基磷灰石之间以及不同成分的含钙结石尚存在困难。Objective To evaluate the forecasting accuracy of dual-energy CT scanning to differentiate different compositions of urinary stone in vivo. Methods Fifty patients with known urinary stone disease admitted in the Southwest Hospital from March 2011 to September 2012 were enrolled in this study. They all underwent scanning preoperatively using a DSCT scanner in the dual-energy mode. CT value, CT different value and CT ratio value of each stone were recorded for the 80 kV and the 140 kV datasets. Based on dual energy software, stone composition was predicted. And these stone samples collected through surgery were analyzed by the infrared spectroscopy as the gold standard. ANOVA was used to compare CT value, CT value difference and CT ratio value of different stone compositions. Meanwhile, the 2 different methods were assessed by Kappa analysis to study their consistency. Results Among 50 stones, there were 4 cases of uric acid （UA） stones and 46 cases of non-UA acid ones （5 mixed stones）. There were statistical differences in CT cystine, 2 hydroxyapatite, 33 CaOx stone, and 6 value, CT difference value and CT ratio value, compared UA stones with other stones （P 〈 0.05 ）. But such differences were seen among the cystine, hydroxyapatite, CaOx, and mixed stones （P 〉 0. 05 ）. Compared the results analyzed by infrared spectrometer, dual energy software correctly diagnosed 4 cases of UA stones, 4 of cystine stones, 33 of CaOx stones, and 2 of mixed stones of UA and CaOx, but misdiagnosed 7 cases, including 1 case of cystine stone and 2 of hydroxyapatite stones misdiagnosed as CaOx stones, and 4 of mixed stones of UA and hydroxyapatite misdiagnosed as mixed ones of cystine and hydroxyapatite. Kappa analysis that the dual energy software and infrared spectroscopy had a test value of 0.705, indicating high consistency. Conclusion Dual-source dual- energy CT scanning has the ability to differentiate UA stones, cystine stones and calcium stones, but it can not distinguish subtypes of calcium stones and hydro

关 键 词：双源CT 双能量扫描 尿路结石 结石成分 

分 类 号：R362[医药卫生—病理学] R691.404[医药卫生—基础医学]