128 层双源 CT 检测冠状动脉粥样硬化斑块中单钠尿酸盐晶体沉积：离体及在体研究。
Monosodium Urate Crystal Deposition in Coronary Artery Plaque by 128-Slice Dual-Energy Computed Tomography: An Ex Vivo Phantom and In Vivo Study.
机构信息
From the Department of Radiology.
Department of Internal Medicine III-Cardiology and Angiology.
出版信息
J Comput Assist Tomogr. 2021;45(6):856-862. doi: 10.1097/RCT.0000000000001222.
OBJECTIVE
Monosodium uric acid (MSU) crystals may accumulate in the coronary plaque. The objective was to assess whether dual-energy computed tomography (DECT) allows for detection of MSU in coronary plaque.
METHODS
Patients were examined with 128-slice DECT applying a cardiac electrocardiogram-gated and peripheral extremity protocol. Patients were divided into 3 groups: gout (tophi >1 cm in peripheral joints), hyperuricemia (>6.5 mg/dL serum uric acid), and controls. The groups were matched for cardiovascular risk factors. Monosodium uric acid-positive (+) and calcified plaque were distinguished, and the coronary artery calcium score was calculated. Ex vivo phantom: MSU solutions were diluted in different NaCL solutions (5%/10%/15%/20%/25%). Coronary artery models with 2 different plaque types (MSU+ and calcified) were created.
RESULTS
A total of 96 patients were included (37 with gout, 33 with hyperuricemia, and 26 controls). Monosodium uric acid-positive plaques were found more often in patients with gout as compared with controls (91.9% vs 0.38%; P < 0.0001), and the number of plaques was higher (P < 0.0001). Of 102 MSU+ plaques, 26.7% were only MSU+ and 74.2% were mixed MSU+/calcified. Monosodium uric acid-positive plaque had mean 232.3 Hounsfield units (range, 213-264). Coronary artery calcium score was higher in patients with gout as compared with controls (659.1 vs 112.4 Agatston score; P < 0.001). Patients with gout had more MSU+ plaques as compared with patients with hyperuricemia (91.6% vs 2.9%; P < 0.0001), and coronary artery calcium score was higher (659.1 vs 254 Agatston score; P < 0.001), but there was no difference between patients with hyperuricemia and controls. Ex vivo phantom study: MSU crystals were detected by DECT in solutions with a concentration of 15% or greater MSU and could be distinguished from calcified.
CONCLUSIONS
Coronary MSU+ plaques can be detected by DECT in patients with gout.
目的
尿酸单钠（MSU）晶体可能在冠状动脉斑块中蓄积。本研究旨在评估双能 CT（DECT）是否可用于检测冠状动脉斑块中的 MSU。
方法
采用 128 层 DECT 对患者进行检查，应用心脏心电图门控和外周肢体协议。将患者分为 3 组：痛风（关节周围有 >1cm 的痛风石）、高尿酸血症（>6.5mg/dL 血清尿酸）和对照组。为了匹配心血管危险因素，对各组进行了匹配。区分尿酸阳性（+）和钙化斑块，并计算冠状动脉钙评分。离体研究：将 MSU 溶液稀释于不同的 NaCl 溶液（5%/10%/15%/20%/25%）中。创建了具有 2 种不同斑块类型（MSU+和钙化）的冠状动脉模型。
结果
共纳入 96 例患者（37 例痛风、33 例高尿酸血症和 26 例对照组）。与对照组相比，痛风患者的尿酸阳性斑块更常见（91.9% vs 0.38%；P<0.0001），斑块数量更多（P<0.0001）。102 个 MSU+斑块中，26.7%为单纯 MSU+，74.2%为混合 MSU+/钙化。尿酸阳性斑块的平均 Hounsfield 单位为 232.3（范围 213-264）。与对照组相比，痛风患者的冠状动脉钙评分更高（659.1 vs 112.4Agatston 评分；P<0.001）。与高尿酸血症患者相比，痛风患者的尿酸阳性斑块更多（91.6% vs 2.9%；P<0.0001），冠状动脉钙评分更高（659.1 vs 254Agatston 评分；P<0.001），但高尿酸血症患者与对照组之间无差异。离体研究：在浓度为 15%或更高的 MSU 溶液中，DECT 可检测到 MSU 晶体，并可将其与钙化区分开来。
结论
DECT 可在痛风患者中检测到冠状动脉 MSU+斑块。
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