| ObjectiveGout is a common metabolic disease, and has a tendency to increase year by yearin our country recently. In the past clinical use blood uric acid levels in combinationwith the joints biopsy for diagnosis, but its sensitivity and invasive puncture operationare restricted the diagnosis accuracy, therefore by the latest using imaging methods fornoninvasive detection urate crystals deposit in peripheral joints has increasingly becomethe focus of current clinical work. Conventional imaging in diagnosis such as X-ray, CT,MRI, but the specificity and sensitivity of the various methods are limited. The latestenergy spectrum CT due to the application of spectral imaging technology with doubleKvp as the core achieve the simulation of material separation of human tissue, canmeasure simulated base material content of various tissues in peripheral joints. Becauseof tophus in gout patients’ peripheral joints has contained many uric acid salt, we canobtain noninvasive diagnosis of gout by detecting urate deposition in peripheral joints.This study using material separation technology of energy spectrum CT, discusses theapplication value in detecting urate deposition of peripheral joints in gout patients usingits base material images based on spectral imaging, and provide a new imaging tool fordiagnosis of gout. MethodsCase group for31cases with clinical and laboratory diagnosis of gout patients,control group for10cases of normal volunteers, peripheral joints of case group withsuspected tophus sedimentation and local ankle joint of control group underwent GEenergy spectrum CT (Discovery CT750HD) scan on spectrum scanning mode(GSI).Data were transmitted to AW4.4workstation to obtain images(uric acid(calcium) baseimage, calcium(uric acid) base image, water(calcium) base image and calcium(water)base image)with GSI Viwer. Choose uric acid(calcium) base image to find all tophuswhich diameter over10mm in case group, choosing appropriate interest area to obtainbase concentration parameters(including the uric acid(calcium) concentration,calcium(uric acid) concentration, calcium(water) concentration and water(calcium)concentration), analyze and compare the differences of base material concentrationparameters between tophus, muscle, cortical bone and cancellous bone within the samelevel in case group, the analysis and comparison ware also made between groups ofmuscle, cortical bone and cancellous bone in case group and control group. UsingSPSS16.0for statistical analysis, comparison in case group using single factor varianceanalysis, comparison between case group and control group using matching t test..Results1.Comparisons in case groupThe base material concentration of tophus（uric acid(calcium) concentration is（1268.82±32.20）mg/cm3，calcium(uric acid) concentration is（19.44±9.50）mg/cm3，calcium(water) concentration is（10.79±9.49）mg/cm3，and water(calcium)concentration i（s1171.03±26.83）mg/cm3）, the base material concentration of cortical bon（euric acid(calcium) concentration i（s1333.59±83.81）mg/cm3，calcium(uric acid)concentration is（271.09±85.04）mg/cm3，calcium(water) concentration is（262.58±85.36）mg/cm3，and water(calcium) concentration is（1230.77±77.03）mg/cm3）, thebase material concentration of cancellous bone（uric acid(calcium) concentration is（1070.88±26.43）mg/cm3，calcium(uric acid) concentration is（85.09±46.88）mg/cm3，calcium(water) concentration is（77.35±46.72）mg/cm3，and water(calcium)concentration is（987.95±23.43）mg/cm3）, the base material concentration of muscle（uric acid(calcium) concentration is（1143.46±15.73）mg/cm3，calcium(uric acid)concentration is（12.34±4.97）mg/cm3，calcium(water) concentration is（4.4±4.92）mg/cm3，and water(calcium) concentration is（1054.13±14.58）mg/cm3）.There were statistically significant differences in concentration of uricacid(calcium) and water(calcium) between two random materials (P <0.05). Therewere also statistically significant differences in concentration of calcium(uric acid) andcalcium(water) between tophus, cancellous bone and cortical bone (P <0.05). But therewas no statistical difference of the calcium(uric acid) concentration and calcium(water)concentration between tophus and muscle.2.Comparisons between case group and control groupCalcium(uric acid) concentration and calcium(water) concentration of cancellousbone and cortical bone was statistically difference between case group and controlgroup, but uric acid(calcium) concentration and water(calcium) concentration ofcancellous bone and cortical bone was no statistically significant. Uric acid(calcium)concentration and water(calcium) concentration of muscle was statistically differencebetween case group and control group, but calcium(uric acid) concentration andcalcium(water) concentration of muscle was no statistically significant.Conclusion1. With the ability of base material mapping, gemstone spectral imaging can easily detect the uric acid salt depositing and calculate base material concentration in tophus ofperipheral joints, and provide a new method for noninvasive diagnosis of gout.2. Furthermore, qualitative analysis of base material concentration in tophus probablycan be used as a follow-up tool in actual clinical care of tophaceous gouty patients,specifically evaluating the efficacy in following the treatment response tourate-lowering agents. |
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