双能量CT在痛风诊断中的临床应用价值分析

Analysis of the Clinical Application Value of Dual-Energy CT in the Diagnosis of Gout

摘要: 目的：探究双能量CT (DECT)在痛风诊断中的应用价值，为临床痛风诊断及病程评估提供影像学依据，提高诊疗效果及患者的生活质量。方法：选取2024年9月~2025年12月本院收治的100例高尿酸血症和痛风患者，均分别采用金标准检查和双能量CT扫描检查，采用DECT Gout软件识别标记尿酸盐结晶，统计DECT诊断痛风的敏感度、特异度，并对照分析DECT在患者不同发病阶段关节病变检出率。结果：100例患者中金标准阳性87例，双能量CT阳性89例，真阳性、假阳性分别为84例、5例，真阴性、假阴性分别为8例、3例，AUC值为0.79，诊断灵敏度为96.55%、特异度为61.54%；按照病程分为无症状高尿酸血症期、急性发作期、发作间歇期及慢性痛风石病变期，随病程不断进展，患者尿酸盐结晶检出率及骨质破坏发生率整体呈上升趋势，组间差异均存在统计学意义(P < 0.05)。结论：双能量CT对痛风尿酸盐结晶具有高度敏感性，且该检查无创、辐射剂量低，能为临床病情评估与治疗方案制定提供影像依据，可评估痛风尿酸盐结晶和骨质破坏情况，判断病程进展风险，指导降尿酸治疗。

Abstract: Objective: To explore the application value of dual-energy CT (DECT) in the diagnosis of gout, provide imaging evidence for clinical diagnosis and disease course evaluation of gout, and improve diagnosis and treatment efficacy as well as patients’ quality of life. Methods: A total of 100 patients with hyperuricemia and gout admitted to our hospital from September 2024 to December 2025 were enrolled. All patients underwent examination by the gold standard and DECT scanning respectively. The DECT Gout software was applied to identify and label monosodium urate (MSU) crystals. The sensitivity and specificity of DECT for gout diagnosis were calculated, and the detection rates of joint lesions detected by DECT in patients at different disease stages were compared and analyzed. Results: Among the 100 patients, 87 were positive by the gold standard and 89 were positive by DECT. There were 84 true-positive cases, 5 false-positive cases, 8 true-negative cases and 3 false-negative cases. The AUC value was 0.79, with a diagnostic sensitivity of 96.55% and specificity of 61.54%. Patients were stratified into asymptomatic hyperuricemia stage, acute attack stage, intercritical period and chronic tophaceous gout stage according to disease course. With the progression of disease course, the detection rate of MSU crystals and incidence of bone erosion showed an overall upward trend, and the differences between groups were statistically significant (P < 0.05). Conclusion: DECT presents high sensitivity for detecting MSU crystals in gout. As a non-invasive examination with low radiation dose, it can supply imaging support for clinical condition assessment and therapeutic regimen formulation. It is capable of evaluating MSU crystal deposition and bone destruction, predicting the risk of disease progression, and guiding urate-lowering therapy.