[1]任洁,周毅,吴会霞,等.双能CT检查在痛风性关节炎中的应用价值[J].南方医科大学学报,2015,(03):384.
点击复制

双能CT检查在痛风性关节炎中的应用价值()
分享到:

《南方医科大学学报》[ISSN:/CN:]

卷:
期数:
2015年03期
页码:
384
栏目:
出版日期:
2015-03-20

文章信息/Info

Title:
Value of dual-energy computed tomography in the diagnosis of gouty arthritis
作者:
任洁周毅吴会霞朱丽花蔡香然
关键词:
痛风双能CT尿酸盐结晶类风湿关节炎强直性脊柱炎
Keywords:
gout dual energy ct urate crystal rheumatoid arthritis ankylosing spondylitis
摘要:
目的探讨双能CT(DECT)检查在痛风性关节炎中的应用价值。方法61例痛风性关节炎患者、30例强直性脊柱炎(AS)
及30例类风湿关节炎(RA)患者行第2代DECT对最痛部位包括手腕关节或肘关节或膝关节或足踝关节及腰椎、骨盆和骶髂关
节进行扫描。用DE Image view处理软件独立分析、评价,以检查部位有绿色伪彩结晶沉积作为诊断依据。记录患者人口统计
学资料、血尿酸水平。3 例痛风患者穿刺活检检查尿酸盐结晶,与DECT结果进行比对。10例入组时DECT显示有尿酸盐结晶
沉积的慢性痛风患者服用降尿酸药物6月后复查相同关节部位DECT,比较治疗前后尿酸盐沉积情况。结果痛风性关节炎组、
AS组、RA组DECT(+)分别为98.4%(60/61),13.3%(4/30)、6.7%(2/30)(χ2=95.522,P<0.05)。21 例急性痛风性关节炎患者中
DECT(+)为95.2%(20/21),40例慢性痛风性关节炎患者中DECT(+)为100%(40/40)。3组高尿酸血症患者比例分别为60.7%
(37/61),30%(9/30),23.3%(7/30)。3 组高尿酸血症的患者中DECT(+)分别为97.3%(36/37), 44.4%(4/9), 28.6%(2/7)(χ2=
24.197,P<0.05)。痛风组共发现344 处尿酸盐结晶, 最常出现结晶沉积的部位依次为第一跖趾关节(22.1%)、第一趾中远端
(19.8%)、跟骨(17.4%)、胫骨下端(13.4%),AS组共发现17处尿酸盐结晶,RA组共发现5处尿酸盐结晶。3例穿刺活检发现尿
酸盐结晶的痛风患者, DECT 在活检部位均检测到绿色标记的尿酸盐沉积。10例DECT显示有尿酸盐结晶沉积的慢性痛风患
者服用降尿酸药物6月后复查相同关节DECT,发现局部尿酸盐结晶减少。结论DECT可以清晰显示尿酸盐结晶, 有助于痛风
与其他关节炎的鉴别诊断及随防。
Abstract:
Objective To investigate the value of dual-energy computed tomography (DECT) in the diagnosis of gouty arthritis.
Methods Sixty-one patients with gout, 30 with ankylosing spondylitis and 30 with rheumatoid arthritis were included in the
study. DECT scans of the hands, wrists, elbows, feet, ankles, knees, lumbar, pelvis and sacroiliac joint were performed. For
post-processing, a color-coding gout software protocol was used. The demographic data and blood uric acid levels were
recorded. For 3 gout patients, the findings of puncture biopsy and DECT were compared. Ten gout patients with urate crystal
deposition upon recruitment underwent DECT scans again after a 6-month urate-lowering therapy. Results The positivity
rates of DECT scan differed significantly among the patients with gout, ankylosing spondylitis and rheumatoid arthritis [98.4%
(60/61), 13.3% (4/30), and 6.7% (2/30), respectively; χ2=95.522, P<0.05). Of the 21 patients with acute gouty arthritis, 20 (95.2%)
showed positive DECT finding, and all the 40 patients with chronic gouty arthritis showed positive findings. In the patients
with patients with gout, ankylosing spondylitis and rheumatoid arthritis, the positivity rates of hyperuricemia were 97.3%(36/
37), 44.4%(4/9), and 28.6%(2/7), respectively (χ2=24.197, P<0.05). A total of 344 urate deposition sites were detected in the gout
patients, involving most commonly the first metatarsophalangeal joint (22.1%), the middle and distal end of the first phalanges
of the toes (19.8%), the calcaneus (17.4%), and the inferior extremity of the tibia (13.4%). Seventeen and 5 urate deposition sites
were found in ankylosing spondylitis patients and rheumatoid arthritis patients, respecitvely. The 10 gout patients receiving a
6-month urate-lowering therapy showed decreased urate deposition on DECT scan. Conclusions DECT scan can detect urate
deposition to allow differentiation diagnosis and follow-up in gout patients.
更新日期/Last Update: 1900-01-01