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目的比较高频超声检查与双源CT(DECT)在诊断痛风性关节炎中的临床价值。方法选择2014年4月-2016年3月医院接受治疗的痛风性关节炎患者58例(276个关节),均采用高频超声及DECT影像学检查,对比关节病变情况。结果针对尿酸盐结晶、关节积液及骨侵蚀指标,高频超声及DECT两种检查措施检出病变关节数量比较差异无统计学意义(P>0.05)。两种检查措施检查一致性水平κ分别为0.560、0.739以及0.818(P<0.05)。58例患者均确诊为痛风性关节炎,其中26例为处于急性期,32例为慢性痛风性关节炎,主要表现为双轨征、暴风雪征、痛风石及血流信号等。急性期、慢性期患者在高频超声中显示痛风石、团状强回声及血流信号,差异有统计学意义(P<0.05),而双轨征、暴风雪征差异,无统计学意义(P>0.05)。结论在痛风性关节炎患者临床确诊过程中应用高频超声及DECT两种检查,均显示良好的诊断价值,但针对尿酸盐结晶而言,DECT检查具有更好的诊断意义。
Objective To compare the clinical value of high-frequency ultrasonography and double-source CT (DECT) in the diagnosis of gouty arthritis. Methods 58 patients (276 joints) with gouty arthritis admitted to our hospital from April 2014 to March 2016 were examined by high-frequency ultrasound and DECT imaging to compare the joint pathological changes. Results There was no significant difference in the number of diseased joints between urate crystals, joint effusion and bone erosion, high frequency ultrasound and DECT (P> 0.05). The consistency of test kappa for both measures was 0.560, 0.739 and 0.818, respectively (P <0.05). 58 patients were diagnosed as gouty arthritis, of which 26 cases were in acute stage, 32 cases of chronic gouty arthritis, mainly manifested as double track sign, snowstorm, tophi and blood flow signals. The patients with acute phase and chronic phase showed tophi, clustery echogenic and blood flow signals in high-frequency ultrasound with significant difference (P <0.05), while there was no significant difference between double-track syndrome and snowstorm syndrome (P> 0.05). Conclusions Both high-frequency ultrasound and DECT can be used in the diagnosis of patients with gouty arthritis. Both of them show good diagnostic value. However, for the diagnosis of urate crystals, DECT has better diagnostic value.