| Objective To evaluate the diagnostic value of urate crystal deposition around lower limb joints in gouty arthritis by gemstone spectral computed tomography and to analyze the sensitivity,specificity,accuracy and feasibility of the gemstone spectral computed tomography.Methods Sixty patients with joint swelling and/or pain or serum uric acid levels increased to the Affiliated Hospital of Qingdao University from January to October in 2016 were enrolled in the study.According to clinical and laboratory tests,the patients were divided into two groups as experimental group.Group A included 30 patients with hyperuricemia and suspected acute gout in,26 males and 4 females,and group B included 30 patients suffered from gouty arthritis by clinical diagnosed in 26 males and 4 females.Fifteen patients with other types of arthritis were enrolled in the same period as the control(group C),11 males and 4 females included.All of the patients were performed gemstone spectral computed tomography imaging on ankle and knee joints.The post-processing and analysis of imaging data was on GE AW4.6 workstation with GSI Viewer software.And the uric acid(calcium)graph and Calcium-based(uric acid)map was obtained from the material separation images.Two senior CT imaging physicians using double-blind reading,observed in the experimental group and the control group around the joints with orbital deposition,and record the location,number,shape and adjacent Joint bone damage.To compare the difference of serum uric acid level between the experimental group and the urinary acid in the normal patients,and to analyze the detection rate of uric acid crystals in the lower limb joint between the three groups.To evaluate the sensitivity and specificity of the diagnosis of gout.SPSS19.0 was used to statically analyze the data.The normality test was conducted and the data of normal distribution were expressed by mean ± standard deviation(x±S).The relevance indicator among the three groups was analyzed by one-way ANOVA.?2 testing was used for comparison among classification and counting materials.The test level was statistically significant(p<0.05).Results By comparing three groups by sex and age,there were no statistic significance in differences among the three groups(page=0.249,psex=0.452,p>0.05).In the 52 patients with hyperuricemia,41 cases of uric acid crystals were detected by gemstone spectral computed tomography.Among the 8 cases of normal serum uric acid,3 cases were detected,as for the group with increased serum uric acid value,its deposition of uric acid was significantly higher than that of the group with normal uric acid value,and there was statistic significance in difference between those two groups(x2=9.900,p=0.002<0.05).As for the detection rate of urate crystals,the order from big to small was group B>group A>group C,and the chronic gout group had the highest detection rate.Compared with the control group,the difference was statistically significant(p<0.05).The sensitivity of the spectrum was 90%,the specificity was 80%,the false negative rate was 10%,the false positive rate was 20%,the positive predictive value was 95.74%,and the negative predictive value was 61.52%.Conclusions Gemstone spectral computed tomography imaging technology has a good ability to show the deposition of urate crystals around the lower limb joints,the sensitivity,specificity,accuracy and feasibility are high,can detect the clinical examination is not easy to find in the small joints of uric acid crystals.It has high detection rate for hyperuricemia,early gout and suspected gout,and provides a new method of examination for noninvasive diagnosis of gout.Thus,it has a high clinical value. |
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