常规CT扫描中尿酸结石与非尿酸结石的区别  

Difference between uric acid stones and non-uric acid stones in conventional CT scanning

作　　者：刘欢[1,2] 杨学东 石凤祥[1] 吴哲[2,3] 孙昊 金征宇[2] LIU Huan;YANG Xue-dong;SHI Feng-xiang;WU Zhe;SUN Hao;JIN Zheng-yu(Department of Radiology,Guang anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053;Department of Radiology,Peking Union Medical College Hospital,Peking Union Medical College&Chinese Academy of Medical Sciences,Beijing 100730;Department of Radiology,Fushun Central Hospital,Fushun 113006,China)

机构地区：[1]中国中医科学院广安门医院放射科,北京100053 [2]中国医学科学院北京协和医院放射科,北京100730 [3]抚顺市中心医院放射科,辽宁抚顺113006

出　　处：《基础医学与临床》2021年第6期885-889,共5页Basic and Clinical Medicine

摘　　要：目的通过测量结石的CT值、大小、密度是否均匀以及结石与肾脏CT值比、身体宽度,找出用常规CT预测尿酸结石的方法。方法共入组尿酸结石50例,非尿酸结石60例,患者在常规CT扫描检出结石后,通过双能量CT区分出尿酸结石与非尿酸结石,选取的结石长径均>7 mm,由一名影像医师在不知道结石成分的情况下,对入组的患者进行数据采集,采用SPSS22.0软件进行统计分析,通过独立样本t检验、卡方检验、受试者工作特征曲线(ROC)评价各指标的预测价值。结果尿酸结石与非尿酸结石的CT值有统计学意义(P<0.01),结石大小、密度是否均匀也具有统计学意义(P<0.05)。用结石CT值诊断尿酸结石具有较高的预测价值,AUC=0.948,灵敏度94%,特异度85%;根据ROC曲线,以CT值730 HU为阈值诊断尿酸结石,其阳性预测值83.9%,阴性预测值94.4%,准确度80.1%。结石的大小也具有一定预测价值,AUC=0.63,灵敏度36%,特异度88.3%;根据ROC曲线以结石平均径>18.05 mm诊断尿酸结石,其阳性预测值72%,阴性预测值62.4%,准确度64.5%。以结石CT值730 HU为阈值且结石密度均匀预测尿酸结石,其特异度100%,阳性预测值100%。结论常规CT通过测量结石CT值、平均径大小、密度是否均匀以鉴别尿酸结石与非尿酸结石具有较高价值,当结石CT值与结石密度是否均匀结合考虑时,则诊断尿酸结石的特异度、阳性预测值明显增高。Objective To investigate methods for predicting uric acid stones with conventional CT by measuring the CT value of stones,mean diameter size,density of stones,stone to kidney CT value ratio,and body width.Methods Patients underwent conventional CT scanning and were diagnosed postoperatively before uric acid stones and non-uric acid stones were detected by dual-energy CT.A total of 50 patients with uric acid stones and 60 patients with non-uric acid stones were enrolled,and after stones were detected by conventional CT scan,uric acid stones and non-uric acid stones were distinguished by dual-energy CT.The selected stones were>7 mm in long diameter.Data acquisition was performed on enrolled patients by a radiologist blinded to stone composition.The predictive value of each index was evaluated by independent sample t test,chi-square test,and receiver operating characteristic curve(ROC).Results There was great value in distinguishing uric acid stones from non-uric acid stones in stone CT value(P<0.01),significant statistical difference in uniform stones or not and in size(P<0.05).The CT scan showed a high predictive value for the diagnosis of uric acid stones,with AUC=0.948,sensitivity as 94%,and specificity as 85%.According to the ROC curve,the CT scaning value of 730 HU was adopted as the threshold for the diagnosis of uric acid stones,with a positive predictive value of 83.9%,a negative predictive value of 94.4%,and an accuracy of 80.1%.The size of the stone also had a predictive value,AUC=0.63,sensitivity 36%,and specificity 88.3%,and the mean diameter of the stone greater than 18.05 mm was defined as a diagnosis standard of uric acid stones according to the ROC curve,which had a positive predictive value of 72%,a negative predictive value of 62.4%,and an accuracy of 64.5%.Using a stone CT value of 730 HU as the threshold combined with a uniform stone density to predict uric acid stones,its specificity was 100%and the positive predictive value was 100%.Conclusions Conventional CT is of high value in differentiati

关 键 词：尿酸结石 常规CT 双能量CT 结石CT值 结石密度是否均匀 

分 类 号：R816.7[医药卫生—放射医学]