平扫CT和双能量CT联合应用对早期痛风的诊断价值  

Diagnostic value of combining non-contrast CT and dual-energy CT for early gout

作　　者：王成达[1] 刘欣 张言巧子 蔡崧[1] 蒋兆贯[1] 吴文娟[2] WANG Chengda;LIU Xin;ZHANG Yanqiaozi;CAI Song;JIANG Zhaoguan;WU Wenjuan(Department of Radiology,the Traditional Chinese Medical Hospital of Wuxi,Wuxi,Jiangsu Province 214002,China;Department of Radiology,Wuxi Second People’s Hospital,Wuxi,Jiangsu Province 214001,China)

机构地区：[1]无锡市中医医院影像科,江苏无锡214002 [2]无锡市第二人民医院影像科,江苏无锡214001

出　　处：《实用放射学杂志》2022年第12期2047-2050,共4页Journal of Practical Radiology

摘　　要：目的探讨平扫CT(NCCT)联合双能量CT(DECT)对早期痛风有症状患者第1跖趾关节影像学改变的诊断价值。方法回顾性选取103例(115个跖趾关节)有疼痛症状患者行第1跖趾关节DECT检查,根据2015年欧洲抗风湿病联盟/美国风湿病学会(EULAR/ACR)标准诊断是否痛风。2位阅片者基于半定量量表独立评估DECT、NCCT+DECT 2组图像,比较2名医师的评分,且一致性结果与诊断结果对照后,采用McNemar统计学方法计算其敏感性、特异性,进行受试者工作特征(ROC)曲线分析,计算曲线下面积(AUC)。结果115个跖趾关节中,72个为早期痛风组,43个为痛风阴性组。结果表明,2位阅片者评分一致性较高(第1组k=0.804,第2组k=0.840)。DECT诊断早期痛风组的敏感性52.8%,特异性100.0%,AUC 0.764,NCCT+DECT敏感性79.2%,特异性93.0%,AUC 0.861,明显高于DECT组(P=0.0004)。结论NCCT和DECT联合分析可提高早期痛风诊断的敏感性,NCCT可补充诊断DECT假阴性病例,提高诊断能力。Objective To investigate the diagnostic value of non-contrast CT(NCCT)combined with dual-energy CT(DECT)for the imaging changes of the first metatarsophalangeal joint in patients with early gout symptoms.Methods A total of 103 patients(115 metatarsopalangeal joints)with pain symptoms underwent DECT examination of the first metatarsophalangeal joint were retrospectively selected,and were diagnosed according to the 2015 European League Against Rheumatism/American College of Rheumatology(EULAR/ACR)criteria.Two viewers independently evaluated DECT and NCCT+DECT images based on a semi-quantitative scale.The consistency of the scores from two physicians was compared with the pathological results,McNemar statistical method was used to calculate the sensitivity and specificity.The receiver operating characteristic(ROC)curves were analyzed,and the area under the curve(AUC)was calculated.Results Of the 115 metatarsopalangeal joints,72 were in the early gout group and 43 were in the gout negative group.The results showed that the scores of the two reviewers were consistent(k=0.804 in the first group,k=0.840 in the second group).The sensitivity,specificity and AUC of DECT for the diagnosis of early gout group were 52.8%,100.0%and 0.764,respectively.The sensitivity,specificity and AUC of NCCT+DECT were 79.2%,93.0%and 0.861,which AUC was significantly higher than that of DECT group(P=0.0004).Conclusion Combined analysis of NCCT and DECT can improve the sensitivity of early gout.NCCT can supplement the diagnosis of false negative cases of DECT and improve the diagnostic ability.

关 键 词：痛风 第1跖趾关节 计算机体层成像 

分 类 号：R589.7[医药卫生—内分泌] R814.42[医药卫生—内科学]