目的 探究双能量CT联合肌骨超声鉴别诊断焦磷酸钙沉积病与痛风性关节炎的价值。 方法 回顾性分析痛风性关节炎102例和焦磷酸钙沉积病102例患者的病历资料，分别记为痛风组和钙沉积组。所有患者均行双能量CT和肌骨超声检查，并以关节滑液或关节腔内晶体物质的穿刺结果作为金标准。评估双能量CT、肌骨超声诊断焦磷酸钙沉积病与痛风性关节炎的效能。 结果 痛风组患者的男性比例、血尿酸均高于钙沉积组（P < 0.05）。痛风组患者中膝关节、第一跖趾关节、踝关节的受累率偏高，钙沉积组患者中膝关节、腕关节、肩关节的受累率偏高。痛风组患者的骨皮质不规则、软骨损伤、半月板退行性变的所占比例均低于钙沉积组（P < 0.05）。痛风组患者的双轨征、痛风石、韧带内强回声、肌腱内强回声、骨侵蚀占比高于钙沉积组（P < 0.05），软骨钙化低于钙沉积组（P < 0.05）。双能量CT、肌骨超声及二者联合诊断焦磷酸钙沉积病和痛风性关节炎的灵敏度分别为86.27%、83.33%、94.12%，特异度分别为89.22%、88.24%、86.27%，阳性预测值分别为88.89%、87.63%、87.27%，阴性预测值分别为86.67%、84.11%、93.63%，准确率分别为87.75%、85.78%、90.20%，一致性Kappa值分别为0.755、0.716、0.804。 结论 双能量CT联合肌骨超声在焦磷酸钙沉积病与痛风性关节炎中的诊断效能良好，可用于辅助鉴别诊断两种疾病。

Objective To investigate the utility of dual?energy CT combined with musculoskeletal ultrasonography in differentiating between calcium pyrophosphate deposition disease and gouty arthritis. Methods A retrospective analysis was conducted on the medical records of 102 patients diagnosed with gouty arthritis and 102 patients diagnosed with calcium pyrophosphate deposition disease. These patients were categorized into the Gout group and Calcium Deposition group， respectively， based on their respective diagnoses. All patients underwent dual?energy CT and musculoskeletal ultrasonography examinations， while joint fluid aspiration results or intra?articular crystal material served as the gold standard for diagnosis. The diagnostic efficacy of dual?energy CT and musculoskeletal ultrasonography in discriminating between calcium pyrophosphate deposition disease and gouty arthritis was evaluated. Results In the gout group， the proportion of male patients and serum uric acid levels were significantly higher compared to those in the calcium deposition group （P < 0.05）. The prevalence rates of knee joint， first metatarsophalangeal joint， and ankle joint involvement were higher in the gout group， while knee joint， wrist joint， and shoulder joint involvement rates were higher in the calcium deposition group. The proportions of irregular bone cortex， cartilage injury， and degenerative meniscus changes were lower in the gout group compared to the calcium deposition group （P < 0.05）. The proportions of double contour sign， tophus formation， hyperechoic band within ligaments or tendons， and bone erosion were higher in the gout group compared to the calcium deposition group （P < 0.05）， whereas cartilage calcification was lower in the gout group （P < 0.05）. The sensitivities for diagnosing calcium pyrophosphate deposition disease and gouty arthritis using dual?energy CT scan alone， musculoskeletal ultrasound alone， and their combined use were 86.27%， 83.33%， and 94.12% respectively. The specificities for diagnosing these conditions using dual?energy CT scan alone，musculoskeletal ultrasound alone，and their combined use were 89.22%，88.24%， and 86.27% respectively. The positive predictive values were 88.89%， 87.63%， and 87.27%， respectively. The negative predictive values were 86.67%， 84.11%， and 93.63%， respectively. The accuracies were 87.75%， 85.78%， and 90.20% respectively. The agreement Kappa values were 0.755， 0.716， and 0.804 respectively. Conclusions The integration of dual?energy CT and musculoskeletal ultrasonography exhibits promising diagnostic efficacy in discriminating between calcium pyrophosphate deposition disease and gouty arthritis. This combined approach serves as a valuable adjunctive tool for the diagnosis of both conditions.