能谱CT物质分离技术在鉴别泌尿系尿酸与非尿酸结石中的应用  

Value of Spectral CT Enabled Material Separation in the Identification of Uric Acid and Non-uric Acid Stones in the Urinary Tract

作　　者：孙杰 田兆荣[2] 王志军[2] SUN Jie;TIAN Zhaorong;WANG Zhijun(Department of Radiology,The Second Affiliated Hospital of Air Force Military Medical University;Department of Radiology,General Hospital of Ningxia Medical University,Xi'an 710000,China)

机构地区：[1]空军军医大学第二附属医院放射科 [2]宁夏医科大学总医院放射科,西安710000

出　　处：《中国医学计算机成像杂志》2025年第1期94-98,共5页Chinese Computed Medical Imaging

基　　金：国家自然科学基金(81860538)。

摘　　要：目的:探讨能谱CT物质分离技术在鉴别尿酸结石与非尿酸结石中的应用价值。方法:前瞻性收集2021年4月至2021年10月在我院经能谱CT扫描诊断为泌尿系结石的患者,并获取结石能谱碘/水基图像,于轴位最大层面勾画感兴趣区(ROI)测量结石碘/水物质浓度,与术后结石经红外光谱分析结果进行对照并分组,采用独立样本t检验、Mann-Whitney U检验和受试者工作特征(ROC)曲线分析数据。结果:对于碘基图物质浓度,尿酸结石组与非尿酸结石各亚组间差异均有统计学意义(P<0.05);对于水基图物质浓度,尿酸结石组除与一水草酸钙(COM)+二水草酸钙(COD)+碳酸磷灰石(Cap)结石组间差异有统计学意义(P=0.046<0.05),与其余非尿酸结石各亚组间差异均无统计学意义(P>0.05)。尿酸结石组与COM结石组、与COM+COD结石组、与COM+CaP结石组、与非草酸钙结石组中曲线下面积(AUC)均为1.00,特异度与灵敏度均为100.0%,尿酸结石组与COM+COD+CaP组AUC为0.96,特异度100.0%、灵敏度88.9%;对应的尿酸结石在碘基图表现为低密度,在水基图上表现为高密度。非尿酸结石各亚组中,仅COM结石组与COM+COD结石组、COM结石组与COM+COD+Cap结石组间在碘基图物质浓度的差异有统计学意义(P<0.05),COM结石组与COM+COD结石组AUC为0.62,特异度55.6%、灵敏度84.6%,COM结石组与COM+COD+Cap结石组AUC为0.71,特异度85.7%、灵敏度53.8%;对应的非尿酸结石(含钙结石)在碘基图和水基图上均表现为高密度。结论:能谱CT通过物质分离技术获得的碘基图在鉴别尿酸结石与非尿酸结石及其各亚组有重要价值,为临床甄别尿酸结石制定合理治疗方案提供了依据。Purpose:To evaluate the clinical value of spectral CT material decomposition technology in differentiating uric acid(UA)stones from non-uric acid(non-UA)stones.Methods:Patients diagnosed with urinary stones through spectral CT scans at our hospital between April 2021 and October 2021 were prospectively enrolled.Iodine/water-based images of the stones were acquired,and regions of interest(ROIs)were delineated at the axial maximum layer to measure iodine/water-based material concentrations.These results were compared with postoperative infrared spectroscopy analysis and categorized into groups.Data were analyzed using independent samples t-test,Mann-Whitney U test,and receiver operating characteristic(ROC)curves.Results:For iodine-based material concentrations,statistically significant differences were observed between the UA stone group and all non-UA stone subgroups(P<0.05).For water-based material concentrations,the UA stone group showed a significant difference only when compared with the calcium oxalate monohydrate(COM)+calcium oxalate dihydrate(COD)+carbonate apatite(CaP)stone subgroup(P=0.046<0.05),but no significant differences with other non-UA subgroups(P>0.05).The area under the curve(AUC)values for differentiating UA stones from COM stones,COM+COD stones,COM+CaP stones,and non-calcium oxalate stones were all 1.00,with specificity and sensitivity of 100.0%.The AUC for differentiating UA stones from the COM+COD+CaP subgroup was 0.96,with specificity of 100.0%and sensitivity of 88.9%.UA stones exhibited low density on iodine-based images and high density on water-based images.Among non-UA subgroups,only between COM and COM+COD groups and COM and COM+COD+Cap groups were with statistically significant difference in iodine-based map substance concentration(P<0.05).AUC between the COM and COM+COD groups was 0.62,with specificity of 55.6%and sensitivity of 84.6%,and AUC between the COM and COM+COD+Cap groups was 0.71,with specificity of 85.7%and sensitivity of 53.8%.Non-UA stones(calcium-containing stones)displ

关 键 词：泌尿系结石 计算机体层成像 尿酸结石 CT能谱成像 

分 类 号：R4[医药卫生—临床医学]