第三代双源双能CT在体内预测单纯性泌尿系结石成分的临床应用价值

doi:10.19558/j.cnki.10-1020/r.2021.01.010

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摘要 目的: 探讨第三代双源双能CT（DSDECT）在体内预测单纯性泌尿系结石成分的临床应用价值。方法: 回顾性分析2018年6月—2020年2月接受手术治疗的54例尿路结石患者资料,54例均于术后使用红外光谱法（IRS）分析为单纯性结石,术前均进行DSDECT检查。54例患者共有60枚结石,其中肾结石42枚,输尿管结石17枚,膀胱结石1枚,观察结石在第三代DSDECT扫描下的特征。并结合术前DSDECT预测的结石成分,计算DSDECT预测单纯性结石的诊断效能。结果: 纳入研究54名患者,平均年龄（51.6±13.8）岁,平均BMI（25.5±3.2）kg/m²。根据IRS分析结果,结石成分主要为草酸钙结石、羟基磷灰石、尿酸结石及胱氨酸结石,结合DSDECT分析,对比发现其预测尿酸及胱氨酸结石的准确率均为100%,而预测草酸钙及羟基磷灰石的准确率均为63.3%。DSDECT体内扫描特征显示草酸钙Ratio值（1.57±0.06）与羟基磷灰石Ratio值（1.55±0.07）差异无统计学意义（P>0.05）,但均显著高于尿酸结石（1.03±0.04,P<0.01）及胱氨酸结石（1.33±0.03,P<0.01）。而分析不同强度管电压扫描下的结石CT值发现,100 kV及150 kV管电压下草酸钙结石的CT值[（1 317.53±317.22）HU、（855.91±198.37）HU]均高于同等扫描强度下羟基磷灰石的CT值[（963.56±298.06）HU（P<0.05）、（655.22±203.04）HU],（P<0.01）。结论: 第三代DSDECT能在体内准确的预测尿酸及胱氨酸结石成分,而预测草酸钙及羟基磷灰石的准确率较低。结合其DSDECT结石扫描特征可以进一步帮助区分草酸钙及羟基磷灰石。

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	宋日进

关键词 ：双源双能CT, 泌尿系结石, 结石成分, 红外光谱分析, 准确性

Abstract：Objective: To retrospectively evaluate the diagnostic accuracy of the third generation dual-source dual-energy computed tomography （DSDECT） for predicting the composition of pure urinary calculi in patients with urolithiasis vs. postoperative infrared spectroscopy （IRS） stone analysis. Methods: We retrospectively included 54 consecutive patients with 60 pure urinary stones diagnosed by IRS who underwent DSDECT from June 2018 to February 2020. Patients with known urolithiasis underwent preoperative DSDECT evaluation, and subsequently given surgical removal of the stones. The characteristics of these stones including 42 kidney stones, 17 ureter stones and one bladder stone scanned by DSDECT were recorded. The final determination of stone composition was made using IRS postoperatively. Results of the stone composition from DSDECT were compared to those from postoperative IRS stone analysis as the standard reference. Results: The average age of the patients enrolled in the study was （51.6 ± 13.8） y and average body mass index （BMI） was （25.5 ± 3.2） kg/m². According to the results determined by IRS, 60 pure urinary calculi were divided into four groups： calcium oxalate, hydroxyapatite, uric acid and cystine stones. DSDECT could correctly detect uric acid and cystine stones compared to IRS analysis with accuracy of 100%. However, the accuracy for calcium oxalate and hydroxyapatite stones by DSDECT was only 63.3%. There was no statistically significant difference between ratio values of calcium oxalate （1.57 ± 0.06） and hydroxyapatite （1.55 ± 0.07）（P > 0.05） analyzed by DSDECT which were both significantly higher than those of uric acid （1.03 ± 0.04, P < 0.01） and cystine stones （1.33 ± 0.03, P < 0.01）. Meanwhile, the CT values of calcium oxalate （1 317.53 ± 317.22） and （655.22 ± 203.04） HU detected by DSDECT under 100 kV and 150 kV were both higher than those of hydroxyapatite （963.56 ± 298.06）（P < 0.05） and （855.91 ± 198.37） HU （P < 0.01）. Conclusion: In patients with pure urinary stones, DSDECT could predict uric acid and cystine stones with a satisfactory accuracy, but with a low accuracy for calcium oxalate and hydroxyapatite. It could help discriminate calcium oxalate and hydroxyapatite stones when combined with the stone characteristics detected by DSDECT.

Key words： dual-source dual-energy computed tomography urinary stone stone composition infrared spectroscopy accuracy

收稿日期: 2020-08-13

通讯作者: 宋日进,songrijin@163.com

引用本文:

孟祥虎, 祁良, 孙雪莹, 丛戎, 王增军, 宋日进. 第三代双源双能CT在体内预测单纯性泌尿系结石成分的临床应用价值[J]. 微创泌尿外科杂志, 2021, 10(1): 39-44.
MENG Xianghu, QI Liang, SUN Xueying, CONG Rong, WANG Zengjun, SONG Rijin. Identification of pure urinary stone composition with the third generation dual-source dual-energy CT in vivo. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(1): 39-44.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1652.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2021/V10/I1/39

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