双能量CT痛风识别技术评估痛风性关节炎的临床应用研究

目的 探讨双能量CT对痛风性关节炎的诊断及评估价值。方法 收集2015年12月~2018年3月我院因外周关节疼痛就诊的患者166例，将符合2015年ACR/EULAR痛风分类标准的133例设为实验组，余33例非痛风患者设为对照组，比较两组患者临床资料。所有患者发病关节均行DECT扫描，薄层重组后将图像数据传至西门子Syngo.Via工作站选择GOUT程序进行图像后处理。分析DECT诊断痛风整体、不同时期以及不同部位的敏感性与特异性。分析DECT检测尿酸盐沉积的存在与患者临床资料的相关性，DECT检测尿酸盐体积与慢性痛风患者临床资料的相关性。结果 DECT诊断痛风性关节炎整体灵敏度90.98%，特异度为84.85%。DECT诊断不同病程的痛风:首发、病程≤2年以及病程＞2年，敏感度分别为89.47%、91.49%及91.04%，特异度分别为100.00%、94.12%及69.23%。DECT诊断不同部位的痛风:手/腕部、膝部以及足/踝部，敏感度分别为57.14%、91.18%及89.00%，特异度分别为100.00%、85.71%及80.00%。痛风患者的血尿酸浓度对DECT检测MSU结晶沉积的存在有影响。慢性痛风患者MSU结晶体积与血尿酸浓度呈正相关。结论 DECT诊断痛风性关节炎具有较高的灵敏度及特异度，对于不同病程及部位的痛风性关节炎的诊断有一定优势，可作为评估痛风疗效的辅助工具。

Clinical Application of Dual Energy CT Gout Recognition Technique in the Evaluation of Gouty Arthritis

Objective To evaluate the value of dual energy CT in the diagnosis and evaluation of gouty arthritis.Methods 166 patients with peripheral joint pain in our hospital from December 2015 to March 2018 were collected.133 patients who met the 2015 ACR/EULAR gout classification criteria were set up as experimental group and 33 non-gout patients as control group. The clinical data of the two groups were compared.All the affected joints were scanned by DECT, and the image data were transferred to Siemens Syngo.Via workstation to select GOUT program for image post-processing.To analyze the sensitivity and specificity of DECT in the diagnosis of gout.To analyze the correlation between the presence of DECT and the clinical data of patients with chronic gout, and the correlation between the volume of uric acid and the clinical data of patients with chronic gout by DECT.Results The overall sensitivity of DECT in the diagnosis of gouty arthritis was 90.98%, and the specificity was 84.85%. DECT diagnosed gout in different stages: first, duration≤2 years and duration>2 years, sensitivity were 89.47%, 91.49% and 91.04%, respectively, specificity was 100.00%, 94.12% and 69.23%. DECT diagnosed gout in different parts: hand/wrist, knee and foot/ankle, with sensitivity of 57.14%, 91.18% and 89.00%, respectively, and specificity of 100.00%, 85.71% and 80.00%, respectively. The blood uric acid concentration of gout patients has an effect on the presence of MUC crystal deposition by DECT. The MSU crystal volume in patients with chronic gout was positively correlated with blood uric acid concentration. Conclusion DECT has a high sensitivity and specificity for the diagnosis of gouty arthritis. It has certain advantages for the diagnosis of gouty arthritis in different stages and sites, and can be used as an auxiliary tool to evaluate the efficacy of gout.