摘要
目的运用双源双能CT(DECT)对上尿路结石组成成分初步判断,验证其准确性,并探讨与重要临床参数的关系。方法连续性选择212例确诊上尿路单发结石伴梗阻性肾积水的患者,所有患者均行DECT扫描,对CT混合能量图像上测量的结石面积、最长径,与患者相关实验室检查与肾盂积水程度进行相关分析;分别测量高低能量图像上结石的CT值,采用双能量软件对结石成分进行初步判断,对手术或自然排出取出的离体结石行红外光谱和联合应用化学及高效液相色谱分析,并以此为参照标准,判断DECT对上尿路结石成分诊断正确率。结果212例患者中共有结石212个,肾盂输尿管移行处结石103例(48.6%),输尿管上段结石59例(27.8%),输尿管中段结石22例(10.4%);输尿管下段结石28例(13.2%)。Ⅰ级肾积水137例(64.6%);Ⅱ级肾积水34例(16.0%);Ⅲ级肾积水32例(15.1%);Ⅳ级9例(4.2%)。肾盂输尿管移行处、输尿管上段、下段结石面积和结石最长径与肾积水程度具有相关性,Pearson相关系数及P值为:r=0.476,P=0.000、r=0.617,P=0.000;r=0.412,P=0.01和r=0.381,P=0.03、r=0.792,P=0.000、r=0.779,P=0.000。以红外光谱分析结石成分为参照标准,DECT分析两种成分混合结石的诊断正确率为91.8%,纯草酸钙的诊断正确率为90.3%;以联合应用化学及高效液相色谱分析结石成分为参照标准,DECT分析两种成分混合结石的诊断正确率为100.0%,纯草酸钙的诊断正确率为85.7%;DECT对纯尿酸及胱氨酸的诊断正确率为100%。结论上尿路单发结石以含钙、两种成分混合结石为主,主要成分为草酸钙和碳酸磷混合;结石的面积和最长径与肾积水程度具有相关性;DECT可对上尿路结石的组成成分进行初步判断,为临床个性化治疗提供帮助。
Objective To evaluate the clinical application of dual-source dual-energy CT（ DECT） in preliminary differentiation of stone composition in vivo in patients with obstructive hydronephrosis in the upper tract. Methods By Continuity selection,212 cases of clinically known or suspected of urinary tract stones with obstructive hydronephrosis were gathered. All patients have been confirmed using dual energy CT scan. Correlation anaylsis was calculated between the degree of hydronephrosis and the area of the stones,as well as the longest diameter and laboratory tests. Hounsfield units（ HU） of each stone were recorded on the high and low energy imaging by hand-drawing and Region of interest（ ROI） method. We then used DECT analysis software for the preliminary identification of stone composition. To evaluate the diagnostic accuracy of DECT for the differentiation of urinary stone composition,the result of infrared spectroscopy and chemical method combining high performance liquid chromatography（ HPLC） analysis was used as a reference standard. Results Among212 patients,CT scanning showed that stones were located at the ureteropelvic junction in 103 patients,upper ureter in 59 patients,middle ureter in 22 patients,and in the lower ureter in 28 patients. 137 patients were classified as hydronephrosis Level Ⅰ,34 patients were Level Ⅱ,32 patients were Level Ⅲ,9 patients were Level Ⅳ and none were Level Ⅴ. Correlation Analysis： stone area was correlated with severity of hydronephrosis despite the region of obstruction（ ureteropelvic junction： r = 0. 476,P = 0. 000,upper ureter： r = 0. 412,P = 0. 01,lower ureter： r = 0. 792,P = 0. 000）. The similarpattern was revealed between the longest diameter and severity of hydronephrosis（ ureteropelvic junction： r = 0. 617,P =0. 000,upper ureter： r = 0. 381,P = 0. 03,lower ureter： r = 0. 779,P = 0. 000）. With the infrared spectroscopy and chemical analysis method combining HPLC analysis results as reference standard,the diagnotic accuracy rates of DECT analysis of the two mixed stone components were 91. 8% and 100% and pure calcium oxalate（ CaOx） were 90. 3% and85. 7%. The diagnostic accuracy rates of pure uric acid and cystine were both 100%. Conclusion A Single stone in the upper urinary tract which caused upper urinary obstructive hydronephrosis was mainly composed of mixed calcium ingredient,especially CaO x and hydroxyapatite. Correlations were found between the degree of hydronephrosis and stone area,as well as the longest diameter. In a word,DECT could provide preliminary stone components analysis in upper urinary tract,and help to make individual clinical treatment plans.
出处
《临床放射学杂志》
CSCD
北大核心
2016年第9期1403-1406,共4页
Journal of Clinical Radiology
基金
无锡市科技发展资金资助项目(编号:CSE31N1303)
