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双源CT预测泌尿系统结石化学成分的临床价值

, PP. 568-572

Keywords: 双源CT,双能量扫描,尿路结石,结石成分

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Abstract:

目的评价双源CT双能量扫描体外预测泌尿系统结石成分的准确性。方法对50例泌尿系统结石患者术前行双能量CT扫描,分别测量每枚结石在80kV和140kV成像条件下的CT值、CT值差值和CT值比值。使用双能量结石分析软件预测结石成分。收集患者治疗后结石标本行红外光谱仪分析结石成分,作为金标准,运用方差分析比较不同种类结石之间上述指标的差异;评价2种方法检测结果的一致性。结果50枚结石中尿酸类结石有4枚,非尿酸类结石有46枚(胱氨酸结石?5枚?,羟基磷灰石2枚,草酸钙结石33枚,混合结石6枚)。组间两两比较,尿酸类结石与其他结石的CT值、CT值差值、CT值比值均有统计学差异(P<0.01);草酸钙结石和混合结石与其他结石的CT值、CT值差值、CT值比值均有统计学差异(P<0.05);其余组间两两比较无统计学差异(P>0.05)。与红外光谱仪分析法结果比较,双能量软件正确诊断4例尿酸类结石、4例胱氨酸结石,33例草酸钙结石、2例尿酸与草酸钙混合结石;另外7例误诊,其中1例胱氨酸结石和2例羟基磷灰石双源CT误诊为草酸钙结石,4例尿酸与羟基磷灰石混合结石双源CT误诊为胱氨酸与羟基磷灰石的混合结石。双能量软件分析结果与红外光谱法分析结果Kappa一致性检验值为0.705,二者具有高度一致性。结论双源CT双能量扫描能准确区分尿酸类结石、胱氨酸类结石和含钙结石,但在区分含钙结石和羟基磷灰石之间以及不同成分的含钙结石尚存在困难。

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