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Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Dual-energy Computed Tomography for the Diagnosis of Acute Gouty Arthritis

Author(s): Zengfa Huang, Zuoqin Li, Jianwei Xiao, Yuanliang Xie, Yun Hu*, Shutong Zhang and Xiang Wang*

Volume 18, Issue 3, 2022

Published on: 07 July, 2021

Page: [305 - 311] Pages: 7

DOI: 10.2174/1573405617666210707164124

Abstract

Aims: To investigate the diagnostic value of Dual-energy Computed Tomography (DECT) in Acute Gouty Arthritis (AGA) or patients presenting suspected gouty arthritis.

Methods: This retrospective study was performed in a single centre from May 2017 to August 2018. Two hundred and twenty-six patients with an initial diagnosis of AGA in the preceding 15 days were included. All patients were referred for a DECT scan of the affected joints. The diagnosis criteria of gout with the American College of Rheumatology Classification Standard were regarded as the reference standard.

Results: After filtration, two hundred patients were included in the present study. The sensitivity, specificity, positive predictive value, and negative predictive value of DECT in the diagnosis of all AGA were 83.83%, 60.61%, 91.5%, and 42.55%, respectively. When AGA was subdivided according to the joint site, the sensitivity, specificity, positive predictive value, and negative predictive value were 80.68%, 61.11%, 91.03%, and 39.29% in feet, 93.55%, 40%, 93.55%, and 40% in knees and 87.5%, 71.43%, 91.3%, and 62.5% in ankles, respectively.

Conclusion: DECT had a high sensitivity for the diagnosis of AGA. However, the specificity was limited, particularly for the diagnosis of acute gouty knee arthritis. Prospective multicenter studies of large samples will enhance the application of DECT among AGA patients in the future.

Keywords: Dual-energy CT, acute gouty arthritis, synovial fluid, sensitivity, monosodium urate crystals, retrospective single center study.

Graphical Abstract
[1]
Yu Z, Mao T, Xu Y, et al. Diagnostic accuracy of dual-energy CT in gout: A systematic review and meta-analysis. Skeletal Radiol 2018; 47(12): 1587-93.
[http://dx.doi.org/10.1007/s00256-018-2948-y] [PMID: 29725712]
[2]
Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther 2006; 8(Suppl. 1): S2.
[http://dx.doi.org/10.1186/ar1907] [PMID: 16820041]
[3]
Schueller-Weidekamm C, Schueller G, Aringer M, Weber M, Kainberger F. Impact of sonography in gouty arthritis: Comparison with conventional radiography, clinical examination, and laboratory findings. Eur J Radiol 2007; 62(3): 437-43.
[http://dx.doi.org/10.1016/j.ejrad.2006.12.005] [PMID: 17234377]
[4]
Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: The National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 2011; 63(10): 3136-41.
[http://dx.doi.org/10.1002/art.30520] [PMID: 21800283]
[5]
Strobl S, Halpern EJ, Ellah MA, et al. Acute gouty knee arthritis: Ultrasound findings compared with dual-energy CT findings. AJR Am J Roentgenol 2018; 210(6): 1323-9.
[http://dx.doi.org/10.2214/AJR.17.19199] [PMID: 29702022]
[6]
Underwood M. Diagnosis and management of gout. BMJ 2006; 332(7553): 1315-9.
[http://dx.doi.org/10.1136/bmj.332.7553.1315] [PMID: 16740561]
[7]
Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977; 20(3): 895-900.
[http://dx.doi.org/10.1002/art.1780200320] [PMID: 856219]
[8]
Abdellatif W, Ding J, Khorshed D, Shojania K, Nicolaou S. Unravelling the mysteries of gout by multimodality imaging. Semin Arthritis Rheum 2020; 50(3S): S17-23.
[http://dx.doi.org/10.1016/j.semarthrit.2020.04.009] [PMID: 32620197]
[9]
Baer AN, Kurano T, Thakur UJ, et al. Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: A comparison study with tophaceous gout. BMC Musculoskelet Disord 2016; 17: 91.
[http://dx.doi.org/10.1186/s12891-016-0943-9] [PMID: 26891750]
[10]
Bongartz T, Glazebrook KN, Kavros SJ, et al. Dual-energy CT for the diagnosis of gout: An accuracy and diagnostic yield study. Ann Rheum Dis 2015; 74(6): 1072-7.
[http://dx.doi.org/10.1136/annrheumdis-2013-205095] [PMID: 24671771]
[11]
Dalbeth N, House ME, Aati O, et al. Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: A dual energy CT study. Ann Rheum Dis 2015; 74(5): 908-11.
[http://dx.doi.org/10.1136/annrheumdis-2014-206397] [PMID: 25637002]
[12]
Jia E, Zhu J, Huang W, Chen X, Li J. Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout. Clin Rheumatol 2018; 37(3): 773-7.
[http://dx.doi.org/10.1007/s10067-017-3753-z] [PMID: 28803339]
[13]
Huppertz A, Hermann KG, Diekhoff T, Wagner M, Hamm B, Schmidt WA. Systemic staging for urate crystal deposits with dual-energy CT and ultrasound in patients with suspected gout. Rheumatol Int 2014; 34(6): 763-71.
[http://dx.doi.org/10.1007/s00296-014-2979-1] [PMID: 24619560]
[14]
Annemans L, Spaepen E, Gaskin M, et al. Gout in the UK and Germany: Prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis 2008; 67(7): 960-6.
[http://dx.doi.org/10.1136/ard.2007.076232] [PMID: 17981913]
[15]
Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58(1): 26-35.
[http://dx.doi.org/10.1002/art.23176] [PMID: 18163497]
[16]
Fravel MA, Ernst ME. Management of gout in the older adult. Am J Geriatr Pharmacother 2011; 9(5): 271-85.
[http://dx.doi.org/10.1016/j.amjopharm.2011.07.004] [PMID: 21849262]
[17]
Terkeltaub RA. Clinical practice. Gout. N Engl J Med 2003; 349(17): 1647-55.
[http://dx.doi.org/10.1056/NEJMcp030733] [PMID: 14573737]
[18]
Graf SW, Buchbinder R, Zochling J, Whittle SL. The accuracy of methods for urate crystal detection in synovial fluid and the effect of sample handling: A systematic review. Clin Rheumatol 2013; 32(2): 225-32.
[http://dx.doi.org/10.1007/s10067-012-2107-0] [PMID: 23138881]
[19]
Malik A, Schumacher HR, Dinnella JE, Clayburne GM. Clinical diagnostic criteria for gout: Comparison with the gold standard of synovial fluid crystal analysis. J Clin Rheumatol 2009; 15(1): 22-4.
[http://dx.doi.org/10.1097/RHU.0b013e3181945b79] [PMID: 19125136]
[20]
McQueen FM, Doyle A, Dalbeth N. Imaging in gout what can we learn from MRI, CT, DECT and US? Arthritis Res Ther 2011; 13(6): 246.
[http://dx.doi.org/10.1186/ar3489] [PMID: 22085684]
[21]
Bayat S, Baraf HSB, Rech J. Update on imaging in gout: Contrasting and comparing the role of dual-energy computed tomography to traditional diagnostic and monitoring techniques. Clinical and experimental rheumatology 2018; 114(5): 53-60.
[22]
Choi HK, Al-Arfaj AM, Eftekhari A, et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis 2009; 68(10): 1609-12.
[http://dx.doi.org/10.1136/ard.2008.099713] [PMID: 19066180]
[23]
Bacani AK, McCollough CH, Glazebrook KN, et al. Dual energy computed tomography for quantification of tissue urate deposits in tophaceous gout: Help from modern physics in the management of an ancient disease. Rheumatol Int 2012; 32(1): 235-9.
[http://dx.doi.org/10.1007/s00296-009-1295-7] [PMID: 20016988]
[24]
Dalbeth N, Kalluru R, Aati O, Horne A, Doyle AJ, McQueen FM. Tendon involvement in the feet of patients with gout: A dual-energy CT study. Ann Rheum Dis 2013; 72(9): 1545-8.
[http://dx.doi.org/10.1136/annrheumdis-2012-202786] [PMID: 23334212]
[25]
Dalbeth N, Aati O, Gao A, et al. Assessment of tophus size: A comparison between physical measurement methods and dual-energy computed tomography scanning. J Clin Rheumatol 2012; 18(1): 23-7.
[http://dx.doi.org/10.1097/RHU.0b013e31823e5cda] [PMID: 22157268]
[26]
Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics 2011; 31(5): 1365-75.
[http://dx.doi.org/10.1148/rg.315115510] [PMID: 21918049]
[27]
Glazebrook KN, Guimarães LS, Murthy NS, et al. Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: Initial evaluation. Radiology 2011; 261(2): 516-24.
[http://dx.doi.org/10.1148/radiol.11102485] [PMID: 21926378]
[28]
Glazebrook KN, Kakar S, Ida CM, Laurini JA, Moder KG, Leng S. False-negative dual-energy computed tomography in a patient with acute gout. J Clin Rheumatol 2012; 18(3): 138-41.
[http://dx.doi.org/10.1097/RHU.0b013e318253aa5e] [PMID: 22426590]
[29]
Choi HK, Burns LC, Shojania K, et al. Dual energy CT in gout: A prospective validation study. Ann Rheum Dis 2012; 71(9): 1466-71.
[http://dx.doi.org/10.1136/annrheumdis-2011-200976] [PMID: 22387729]
[30]
Chou H, Chin TY, Peh WC. Dual-energy CT in gout - A review of current concepts and applications. J Med Radiat Sci 2017; 64(1): 41-51.
[http://dx.doi.org/10.1002/jmrs.223] [PMID: 28238226]
[31]
Zhang W, Doherty M, Pascual E, et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006; 65(10): 1301-11.
[http://dx.doi.org/10.1136/ard.2006.055251] [PMID: 16707533]
[32]
Dalbeth N, Choi HK. Dual-energy computed tomography for gout diagnosis and management. Curr Rheumatol Rep 2013; 15(1): 301.
[http://dx.doi.org/10.1007/s11926-012-0301-3] [PMID: 23292817]
[33]
Anonymous . Report of the united nations scientific committee on the effects of atomic radiation to the general assembly. 2000. Available from:http://www.unscear. org/docs/reports/gareport.pdf accessed 12 June 2009.
[34]
McCollough CH, Leng S, Yu L, Fletcher JG. Dual and multi-energy CT: Principles, technical approaches, and clinical applications. Radiology 2015; 276(3): 637-53.
[http://dx.doi.org/10.1148/radiol.2015142631] [PMID: 26302388]

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