双能量CT半定量评分系统在尿酸盐结晶评估中的应用价值

目的 探讨双能量CT（DECT）半定量评分系统在痛风患者尿酸盐结晶评估中的可行性及应用价值。方法 回顾性分析2013年8月至2017年8月江苏大学附属澳洋医院39例痛风患者的足部DECT扫描结果，并对其尿酸盐结晶进行半定量评分。应用DECT定量软件测量尿酸盐结晶体积；采用组内相关系数（ICC）评估半定量评分重复性；使用Spearman相关性分析半定量评分与尿酸盐体积的相关性；同时比较半定量评分方法与定量软件测量尿酸盐体积方法所用时间。结果 39例患者共完成了73只足部扫描，其中69只足部检测到尿酸盐结晶。DECT尿酸盐结晶评分在肌腱中最高，其次为第一跖趾关节、踝/中足关节，脚趾的其他关节评分最低。2名影像医师对尿酸盐结晶的半定量分析结果一致性高，ICC为0.944。69只足部的尿酸盐结晶体积平均值为（2.69±8.84）cm³。DECT尿酸盐评分与其体积密切相关（r=0.479，P<0.001）。两名评分者使用DECT评分系统分析尿酸盐结晶所需时间分别为（68.18±15.16）秒、（74.67±16.15）秒，定量软件分析所需时间为（166.10±13.23）秒，三者之间差异有统计学意义（F=527.029，P<0.001）。结论 DECT尿酸盐结晶半定量评分系统是可行的，相比定量分析软件更省时、方便，值得推广应用。

Application value of dual energy CT semi-quantitative scoring system in urate crystal evaluation

Objective To explore the feasibility and application value of dual energy CT (DECT) semi-quantitative scoring system in the evaluation of urate crystals in patients with gout. Methods A total of 39 feet DECT scans of gout patients in the Affiliated Aoyang Hospital of Jiangsu University from August 2013 to August 2017 were retrospectively analyzed, and DECT was used for semi-quantitative scoring of urate crystallization. The urate crystal volume was measured using DECT quantification software. Intraclass correlation coefficient (ICC) was used to evaluate the semi-quantitative scoring reproducibility. Spearman correlation was used to analyze the correlation between the semi-quantitative score and the volume of urate, and to compare the time taken by the semi-quantitative score method and the quantitative software to measure the volume of urate. Results A total of 73 feet were scanned in 39 patients, and urate crystals were detected in 69 feet. DECT showed the highest score of urate crystal in tendons, followed by the first metatarsophalangeal joint, ankle/midfoot joint, and the lowest score of other joints in toes. The results of semi-quantitative analysis of urate crystal by two radiologists were consistent, ICC was 0.944. The average volume of urate crystal in 69 feet was (2.69±8.84) cm³. DECT urate score was closely related to volume (r=0.479,P<0.001). The time of using DECT scoring system to analyze the crystallization of urate was (68.18±15.16) seconds, (74.67±16.15) seconds, and the time of quantitative software analysis was (166.10±13.23) seconds. There was a significant difference between the three (F=527.029,P<0.001). Conclusion The semi-quantitative score of DECT urate crystals is feasible. Compared with the quantitative software to measure urate crystal volume, it is more time-efficient and convenient to use DECT scoring system, which is conducive to clinical application.