基于双能量能谱CT定量多模态功能成像的痛风早期诊断及治疗疗效的早期评价研究

Gout is a common disease of global one of the upward trend in recent years, the prevalence of gout and prevalence and incidence are getting younger and younger. Previous clinical use of clinically typical symptoms, blood levels of uric acid combined joint puncture to diagnose, but its sensitivity and puncture operation invasive diagnostic accuracy are restricting. Enter clinical dual-energy spectroscopy imaging in recent years as a new technology to identify tissue components, and provide a new platform for the evaluation of the effectiveness of early diagnosis and treatment of gout. Applicant gout tophi in patients with uric acid group concentration and surrounded by other organizations, there are significant differences found in early studies found that the muscle tissue of patients with gout, uric acid group concentration is higher than the normal control group. Spectroscopy CT can evaluate the extent of the damage of the gout, singlet uric acid sodium deposition of crystals, the location and quantity, as well as inflammatory response. However, for the determination of the correlation between the uric acid group concentration and the true value, the early diagnosis of gout and clinical uric acid lowering therapeutic effect in the early follow-up to assess the role is unclear. The purpose of this project is to find the dual-energy spectroscopy CT multi-modal quantitative imaging in the early diagnosis of gout, gout patients with uric acid lowering treatment effects monitoring in early clinical value.

痛风是一种全球性的多发病之一，近年来痛风的患病率及流行率呈上升趋势，且发病有年轻化趋势。以往临床多采用临床典型症状、血尿酸水平结合关节穿刺来进行诊断，但其敏感性及穿刺操作的有创性都制约了诊断的准确性。近年来双能量能谱成像作为一种鉴别组织成分的新技术进入临床，为痛风的早期诊断及治疗效果的评价提供了新的平台。申请者在前期的研究中发现痛风患者痛风结节的尿酸基浓度和周围其他组织都存在明显的差异性，发现痛风患者的肌肉组织的尿酸基浓度高于正常对照组。能谱CT可以评价痛风关节的破坏程度、单尿酸钠晶体的沉积的位置和数量，以及炎性反应。但对于所测定尿酸基浓度与真实值之间的相关性，早期诊断痛风及临床降尿酸治疗效果的早期随访评估的作用还不清楚。本课题旨在发现双能量能谱CT多模态定量成像在早期痛风的诊断，痛风患者降尿酸治疗中早期效果监测的临床应用价值。

痛风是一种全球性的多发病之一，以往临床多采用临床典型症状、血尿酸水平结合关节穿刺来进行诊断，但其敏感性及穿刺操作的有创性都制约了诊断的准确性。近年来双能量能谱成像作为一种鉴别组织成分的新技术进入临床，为痛风的早期诊断及治疗效果的评价提供了新的平台。本项目基于双能量能谱CT多模态定量成像，明确了其在痛风的诊断及治疗中的价值，优化了临床双能量能谱CT多模态定量痛风成像参数，进一步观察分析尿酸盐在膝关节及男性痛风患者足踝关节沉积特点，从而深入了解尿酸盐沉积与痛风性关节炎急性发作的相关解剖学和形态学特征。本项目按期基本完成主要研究内容，其研究结果如下：①双能量能谱CT基物质图像可以方便快捷地检测痛风患者外周关节内的痛风石以及定量测量痛风石内的基物质浓度，多模态定量成像参数中有效原子序数、能谱曲线斜率、最佳单能量、尿酸（钙）含量、钙（尿酸）含量及尿酸（钙）/钙（尿酸）比值有助于尿酸盐的准确诊断，其中尿酸（钙）/钙（尿酸）比值对尿酸含量变化更为敏感。②膝关节双能量能谱CT显示尿酸盐在膝关节周围易沉积于受力较大的肌腱及韧带处（内外侧副韧带处＞交叉韧带＞股四头肌肌腱），推测尿酸盐沉积与所受压力有关。③男性痛风患者足踝关节中，尿酸盐足踝关节周围最容易沉积在软组织下及第一跖趾关节。尿酸盐在足踝关节的沉积部位、形态及数目等对痛风性关节炎的急性发作有影响。④双能量能谱CT有助于非典型临床症状及血尿酸水平正常的痛风的早期诊断，更精确的确定痛风累及的关节范围。本研究证实双能量能谱CT定量多模态成像清晰显示痛风患者尿酸钠结晶的解剖分布特点,为痛风的治疗、预后评估及随访提供更多、更有用的影像学信息。