双能CT能谱曲线分析在泌尿系结石成分鉴别中的多参数诊断效能评估OA

Objective:This study aimed to investigate the diagnostic performance of dual-energy CT(DECT)spectral curve analysis in differentiating urinary tract stone compositions,providing a basis for precise clinical diagnosis and individualized treatment.Methods:A prospective study was conducted on 120 patients with urinary tract stones who visited our hospital from January to December 2023.All patients underwent DECT scanning using a GE Discovery CT 750 HD scanner.Images were reconstructed and analyzed using a GE AW4.6 post-processing workstation.CT values at different energy levels(40 keV and 140 keV)were measured,and curve slope(λHU),dual-energy ratio(DER),and effective atomic number(Zeff)were calculated to evaluate their diagnostic performance.Results:Significant differences were observed in CT values,curve slopes,DER and Zeff among five stone types(cystine,calcium oxalate,uric acid,calcium phosphate,and struvite)(P<0.001).Calcium oxalate stones exhibited the highest CT value at 40 keV[(1892.36±124.81)HU],while uric acid stones had the lowest[(682.47±58.92)HU].Cystine stones showed significantly higher DER(2.98±0.23)compared to other types(P<0.05).The Zeff demonstrated optimal performance in identifying uric acid stones,with an AUC of 0.938(95%CI:0.871～0.980),sensitivity of 90.38%,and specificity of 88.50%.The DER showed the highest diagnostic performance for cystine stones,with an AUC of 0.892(95%CI:0.816～0.946).In identifying calcium oxalate stones,CT value(40 keV)performed best,with an AUC of 0.886(95%CI:0.804～0.941).Conclusion:DECT spectral curve analysis can effectively differentiate various types of urinary tract stones,with different parameters showing varying performance in identifying specific stone types.This technique provides a reliable non-invasive method for analyzing stone composition and offers significant value in guiding individualized clinical treatment.