双能CT在人体泌尿系结石成分分析中的价值  

Application of dual-source CT in the composition analysis of urinary calculi in vivo

作　　者：蔡磊[1] 叶冬晖 陈剑锋[1] 鲁旭 孙家瑜[1] CAI Lei;YE Donghui;CHEN Jianfeng;LU Xu;SUN Jiayu(Department of Radiology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Urology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院放射科,四川成都610041 [2]四川大学华西医院泌尿外科,四川成都610041

出　　处：《现代泌尿外科杂志》2021年第7期578-581,共4页Journal of Modern Urology

摘　　要：目的探讨双源CT双能量参数在区分人体泌尿系结石的价值。方法回顾性分析我院行双源双能量CT扫描的104例泌尿系结石患者的临床资料,共纳入泌尿系结石147枚,以红外光谱分析结果为金标准,将结石分为A、B组:A组(尿酸结石,17枚);B组(含钙结石组,130枚),B组进一步分为3组:B 1组(一水草酸钙结石结石,55枚),B 2组(一水草酸钙+二水草酸钙结石,56枚),B 3组(一水草酸钙+二水草酸钙+碳酸磷灰石,19枚),最后将B 2组与B 3组融合为混合结石组。通过双能量参数计算每组结石的双能比、双能差、双能量指数等指标,对这些指标进行统计学分析,含钙结石多组之间比较采用单因素方差分析;尿酸与含钙结石组之间比较及一水草酸钙组与混合结石组之间比较采用独立样本t检验;绘制受试者工作特征曲线(ROC)进行效能评价。结果①A(尿酸结石)组与B(含钙结石)组双能比、双能差、双能指数比较差异均具有统计学意义(P<0.05)。②B(含钙结石)组中,B 1、B 2、B 3组每两组之间比较双能比、双能指数均有统计学差异(P<0.05),而双能差均无统计学差异(P>0.05)。将B 2组与B 3组融合为混合结石组(B 2组+B 3组),B 1(一水草酸钙结石)组与混合结石组的双能比、双能指数均具有统计学差异(P<0.05),而双能差无统计学意义(P>0.05)。③双能比、双能指数、双能差诊断尿酸结石的AUC分别为0.923(95%CI:0.831-1.000)、0.925(95%CI:0.832-1.000)、0.958(95%CI:0.910-1.000);双能比、双能指数诊断一水草酸钙结石ROC曲线下面积分别为0.899(95%CI:0.849-0.949)、0.794(95%CI:0.719-0.870)。结论双源CT的双能量参数有助于区分体内尿酸结石与含钙结石,在含钙结石中有助于区分体外冲击波碎石疗效不好的一水草酸钙结石与其他含钙结石,能为结石的临床治疗提供有价值的影像信息。Objective To explore the application value of dual-source CT in the differentiation of urinary calculi.Methods The clinical data of 104 patients who underwent dual-source CT scan in our hospital were retrospectively analyzed,including 147 urinary calculi.According to the results of infrared spectrum analysis,the calculi were divided into two groups:group A(urate,n=17),and group B(calcium,n=130).Group B was subdivided into three groups:group B 1(COM,n=55),group B 2(COM+COM,n=56),and group B 3(COM+COD+CaP,n=19).Finally,group B 2 and group B 3 were mixed into one group(B 2+B 3).The dual energy(DE)ratio,DE difference and DE index were calculated for statistical analysis.Results①There were significant differences in DE ratio,DE difference and DE index between group A and group B(P<0.05).②There were significant differences in DE ratio and DE index between B 1 and B 2,B 1 and B 3,and B 2 and B 3,but there was no difference in DE difference(P>0.05).There were significant differences in DE ratio and DE index between B 1 and B 2+B 3(P<0.05),but no difference in DE difference(P>0.05).③ROC analysis of urate calculi yielded that AUC of DE ratio,DE difference and DE index were 0.923(95%CI:0.831-1.000),0.958(95%CI:0.910-1.000),and 0.925(95%CI:0.832-1.000),respectively.ROC analysis of COM calculi showed that AUC of DE ratio and DE index were 0.899(95%CI:0.849-0.949),and 0.794(95%CI:0.719-0.870),respectively.Conclusion The parameters obtained by dual-source CT are helpful to distinguish urate calculi from calcium calculi,and to distinguish COM calculi from other calcium-containing calculi which are lithotripsy-resistant.

关 键 词：泌尿系结石 双源CT 结石成分 双能量成像 双能比 

分 类 号：R445.3[医药卫生—影像医学与核医学]