双能 CT 诊断痛风的诊断性能：系统文献回顾和荟萃分析。
The diagnostic performance of dual energy CT for diagnosing gout: a systematic literature review and meta-analysis.
机构信息
Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Rheumatology, Northwest Clinics, Alkmaar and Den Helder, The Netherlands.
出版信息
Rheumatology (Oxford). 2019 Dec 1;58(12):2117-2121. doi: 10.1093/rheumatology/kez180.
OBJECTIVE
This study aimed to assess the utility of dual energy CT (DECT) for diagnosing gout.
METHODS
A systematic literature search was performed in PubMed, EMBASE and Cochrane Library. Studies evaluating the utility of DECT for diagnosing gout were included. Reference standards were detection of monosodium urate crystals at SF assessment or a validated set of criteria. The methodological quality of studies was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 criteria. Data from person-based and joint-/localization-based evaluations were pooled separately, and subgroup analyses for disease stage/duration and reference standard were performed.
RESULTS
Ten studies were included; in person-based evaluations, the pooled (95% CI) sensitivity and specificity were 0.81 (0.77, 0.86) and 0.91 (0.85, 0.95), respectively. In joint-based evaluations, they were 0.83 (0.79, 0.86) and 0.88 (0.83, 0.92), respectively. At short disease duration (⩽6 weeks), the pooled (95% CI) sensitivity and specificity at the joint level were 0.55 (0.46, 0.64) and 0.89 (0.84, 0.94), respectively.
CONCLUSION
DECT has a high diagnostic accuracy in established gout, but its diagnostic sensitivity is low in subjects with recent onset gout.
目的
本研究旨在评估双能 CT（DECT）在诊断痛风中的应用价值。
方法
系统检索 PubMed、EMBASE 和 Cochrane Library 中评估 DECT 诊断痛风应用价值的研究。纳入标准为 SF 评估时检测到单钠尿酸盐晶体或使用经过验证的标准集。根据 Quality Assessment of Diagnostic Accuracy Studies（QUADAS-2）标准评估研究的方法学质量。分别对基于个体和基于关节/定位的评估进行数据合并，并对疾病分期/持续时间和参考标准进行亚组分析。
结果
共纳入 10 项研究；在基于个体的评估中，合并的（95%CI）敏感性和特异性分别为 0.81（0.77，0.86）和 0.91（0.85，0.95）。在基于关节的评估中，敏感性和特异性分别为 0.83（0.79，0.86）和 0.88（0.83，0.92）。在疾病持续时间较短（⩽6 周）时，关节水平的合并（95%CI）敏感性和特异性分别为 0.55（0.46，0.64）和 0.89（0.84，0.94）。
结论
DECT 对确诊痛风具有较高的诊断准确性，但在发病近期的痛风患者中，其诊断敏感性较低。
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