摘要
目的评价双能CT(DECT)彩色编 码图检测尿酸盐沉积的临床价值。方法 24例痛风患者纳入本研究,其中有痛风史 者13例(根据美国风湿病协会标准),临床 怀疑痛风者6例,另5例检查前未考虑到痛 风可能性。根据不同检查部位,分别进行 DECT扫描,同时获得140、80kvp和混合能 量图(相当于常规单能量120KV图像),利 用DECT Gout软件后处理得到伪彩色编码 图,分别由2名医师对平均加权120kvp图 和伪彩色编码图独立进行评价,主要观察 尿酸盐沉积的部位、数目、大小等。结 果 24例均显示不同部位、数目、大小的 尿酸盐沉积,DECT彩色编码图较混合能量 图(相当于常规单能量120KV图像)显示了 更多数目的痛风石,具有更强的显示尿酸 盐结晶的能力(P<0.05)。对于13例临床确 诊痛风患者,DECT能更好显示微小、亚临 床部位的痛风石;对于6例临床可疑痛风 患者及5例之前未考虑到痛风可能性的患 者,明确或提示了痛风的诊断。两位医师 利用DECT彩色编码图评估痛风石数目的差 异无显著性(P>0.05),而利用混合能量图 (相当于常规单能量120KV图像)差异有显 著性(P<0.05)。结论 DECT彩色编码图具 有更强的显示痛风石能力,且更为形象直 观,可作为痛风筛查手段,有助于全面评 估病情,具有较大的临床应用价值。
Objective To assess the clinical value of dual energy computed tomography (DECT) color-coded map for detect uric acid deposition. Methods 24 cases of gout patients enrolled in the study, 13 cases with a history of gout (according to the American College Rheumatology Criteria), clinical suspicion of gout were 6 cases, the other 5 cases did not take into account the possibility of gout before the examination. DECT dual-energy scanning was conducted to obtain 140,80 kvp and hybrid energy diagram(equivalent to conventional energy120 KV single image) simultaneously at different checkpoints. Pseudo-color coded map was derived after processing by DECT Gout software. Two physicians independently evaluate the average weighted 120 kvp diagrams and pseudo-color coded map respectively, mainly observing the location, number and size of urate deposition. Results All of the 24 cases have showed the different location, number, size of urate deposition, DECT color-coded map has represented a greater number of urate deposition than mixing energy tomography (equivalent to conventional energy 120 KV single image) and have a stronger capability to display more urate deposition(P<0.05). For 13 cases of gout confirmed by clinical,DECT was more excellent for demonstrating the urate deposition in tiny subclinical parts for the 13 cases of gout confirmed by clinical and could make a definitive or suggest diagnosis for the 6 cases of clinically suspicious and five cases of gout patients not previously taken into account the possibility of gout.Two physicians to assess urate deposition numbers which used of DECT has no significant difference (P> 0.05), and the use of hybrid energy imaging (equivalent to conventional energy 120 KV single image) has significant difference (P <0.05). Conclusion DECT has stronger ability in displaying urate deposition, further more,it can be used as screening of gout. DECT is of clinical worthy in a comprehensive assessment of the clinical condition and clinical application.
【关键词】痛风;尿酸盐结晶;双能量CT
【中图分类号】R589.7; R445.1
【文献标识码】A
【DOI】10.3969/j.issn.1672-5131.2015.07.030
前言
痛风(gout)是嘌呤代谢紊乱所致的一组慢性疾病,痛风石是由于 机体嘌呤代谢紊乱和(或)尿酸排泄障碍导致血尿酸持续增高,尿酸盐 结晶不断沉积于组织器官引起的慢性炎症和纤维组织增生所形成的结 节肿,引起关节僵硬、活动受限等。沉积于肌腱、韧带和神经等部位 的痛风石还可导致肌腱韧带破坏、断裂及神经变性、水肿和卡压等, 从而导致一系列不可逆后果[1-4]。因此,全面、系统的评估痛风石沉 积的部位、数目、大小对指导临床治疗具有十分重要的意义。双能 CT(Dual energy CT,DECT)是近年发展起来的一种检测痛风石的新技 术,可以更好的检测体内沉积的尿酸盐结晶[5-9]。本研究对24例最终临 床确诊痛风患者行前瞻性DECT成像,探讨DECT彩色编码图在检测尿酸 盐沉积上的应用价值。
中国CT和MRI杂志
第13卷, 第 7 期
2015年07月
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