Combining Hyperechoic Aggregates and the Double-Contour Sign Increases the Sensitivity of Sonography for Detection of Monosodium Urate Deposits in Gout

Zhu, Liang; Zheng, Shenzhou; Wang, Wenwen; Zhou, Qing; Wu, Huaxiang

doi:10.7863/ultra.16.03046

Cited by 10 publications

(10 citation statements)

References 21 publications

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“…In this study, it is found that uric acid had a significant meaning on precipitate findings by using ultrasound in the form of DCS, which was found in hyperuricemia conditions as many as 13 samples (76.5%) while in 7 samples (29.2%) normal uric acid levels were found. This can be explained and in line with research conducted by Thiele who stated that the image of DCS would disappear if uric acid was maintained at the level of ≤6mg/dl and the loss of DCS would take about 8-18 months after uric acid levels were maintained below normal values (16). However, in this study, no information was available related to uric acid st levels and ultrasound imaging of the 1 MTP prior to the beginning of the study, so it was not known whether the existing DCS image was a new form of crystalline precipitate or a precipitated crystal deposit that had formed before.…”

Section: Table 1 Distribution Of Sample Characteristics By Demographicssupporting

confidence: 86%

“…This difference in distribution could be caused by the activeness of the joints in movement which could trigger the movement of uric acid crystals to be deposited on the surface of the cartilages or deposited in the surrounding tissue as tophus. Although statistically not significant (P>0.05), when seen in the normouricemic group in this study, no aggregate image was found in the whole sample (16).…”

Section: Table 1 Distribution Of Sample Characteristics By Demographicscontrasting

confidence: 78%

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Correlation between Ultrasound Findings of Uric Acid Precipitate in MTP I and Acute Gout Flare in Gouty Arthritis

Susanti

Ilyas²,

Idris³

et al. 2020

JKB

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<p>Acute gout flare is the most common manifestation of gouty arthritis that intermittently occurs with severe pain in the joints due to interactions between monosodium urate crystals (MSU) and the surrounding tissues. The most common predilection is the metatarsophalangeal joint (the 1st MTP). Ultrasound examination is a modality that can be used to visualize MSU crystal precipitates in and around joints. This study aimed to determine the correlation between the findings of the MSU crystal precipitate on the 1st MTP using ultrasound with the occurrence of acute gout flare in gout patients. This study was an analytical observational study with a cross-sectional method. The samples were 41 patients with a history of previous acute flares and in the intercritical phase when participating in the study. Examinations of ultrasound on the 1st MTP and random serum uric acid level were performed. Evaluations were carried out on both of the 1st MTPs to assess the shape of the MSU crystalline precipitate, namely Double Contour Sign (DCS), aggregate, and tophus. Each sample was evaluated within five days to assess the presence or absence of an acute flare. The diagnostic tests used were the Chi-Square Test and the Fischer Exact Test with a significance value of p <0.05. The results showed the images of DCS were seen in 20 samples with 9 (45%) samples experiencing acute flare (p <0.05), while in 21 samples where no DCS were found, all did not experience any flare. Findings of aggregate and tophus were rarely found, 7.3% and 4.9%, respectively. In this study, the finding of DCS precipitates using ultrasound has a significant correlation to the emergence of acute flare and is a significant form of precipitate findings in this study, whereas aggregate and tophus precipitates are difficult to determine.</p>

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Section: Table 1 Distribution Of Sample Characteristics By Demographicssupporting

confidence: 86%

Section: Table 1 Distribution Of Sample Characteristics By Demographicscontrasting

confidence: 78%

Correlation between Ultrasound Findings of Uric Acid Precipitate in MTP I and Acute Gout Flare in Gouty Arthritis

Susanti

Ilyas²,

Idris³

et al. 2020

JKB

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“…In our study, DCS and tophi were frequently detected by US in gout patients, and they are notably increased with the disease history of gout. HAG was reported to be the most common sign at the early stage, especially in asymptomatic joints [20]. In an animal experiment where MSU was injected into the knees of rabbits, HAG was found frequently displayed in 75% of knees at an early stage (day 7 after MSU injection) [21].…”

Section: Discussionmentioning

confidence: 99%

Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

Cao

Zhao

Xie

et al. 2021

Journal of Immunology Research

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Objective. To evaluate monosodium urate (MSU) crystal deposition and related lesions in the joints of patients with gout and hyperuricemia (HUA) using ultrasound. To explore the association between ultrasound findings and clinical features in gout and HUA. Methods. A total of 202 patients with gout and 43 asymptomatic patients with HUA were included. The clinical data and ultrasonic assessment results were collected and statistically analyzed. Results. Deposition of MSU crystals was found in 25.58% (11/43) of patients with asymptomatic HUA and 76.24% (154/202) of patients with gout. Of the 1,082 joints from patients with gout examined, 33.09% (358/1082) displayed MSU crystal deposition. In the joints with MSU crystal deposition, 77.37% (277/358) had a history of attacks. Among the joints of gouty arthritis, double contour sign (DCS), hyperechoic aggregate (HAG), and tophi were found in 32.65% (159/487), 7.80% (38/487), and 24.64% (120/487) of the joints, respectively. DCS and tophi, but not HAG, increasingly appeared with the extension of gout duration. In patients with more than 15 years of gout history, DCS, Tophi, and HAG were found in 48.18%, 40.00%, and 6.36% of US assessed joints, respectively. In patients with gout, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. The synovial lesion was related to HAG, while bone erosion was related to tophi and DCS. Nephrolithiasis was detected in 20.30% (41/202) of patients with gout and 4.65% (2/43) of HUA patients, indicating that nephrolithiasis occurred in more patients with gout than in patients with HUA. Conclusion. HAG is an early performance of MSU crystal deposition in joints of gout and HUA. Both DCS and tophi are risk factors for bone erosion. Early urate-lowering therapy (ULT) should be considered in patients with gout, DCS, or tophi.

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“…The detection rate of them was notably increased with the disease history of gout, but not the HAG. HAG was reported to be the most common sign at early stage, especially in asymptomatic joints (20). In animal experiment, MSU was injected into the knees of rabbits, HAG was found frequently displayed in 75% knees at early stage (day 7 after MSU injection) (21).…”

Section: Discussionmentioning

confidence: 99%

Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

Cao

Zhao

Xie

et al. 2020

Preprint

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Objective Evaluation of monosodium urate (MSU) crystal deposition and related lesion in joints using ultrasound in gout and hyperuricemia patients. Methods Total 202 gout patients and 43 asymptomatic hyperuricemia patients were included, the clinical data and ultrasounic assessment results were collected and statistically analyzed. Results Deposition of MSU crystals were found in 25.58% (11/43) of the patients with asymptomatic hyperuricemia and 76.24% (154/202) of the patients with gout. In the all examined 1082 joints from gout patients, 33.09% (358/1082) of them were detected MSU crystals. In MSU crystal positive joints, 77.37% (277/358) of them had history of attacks. Among the joints of gouty arthritis, 56.88% (277/487) of them were found MSU crystals. Double contour sign (DCS), hyperechoic aggregate (HAG) and Tophi were found in 32.65% (159/487), 7.80% (38/487) and 24.64% (120/487) of the joints, respectively. DCS and Tophi, but not HAG, appeared inceasingly in gout duration extension. In the patients with more than 15 years of gout history, DCS, Tophi and HAG were found in 48.18%, 40.00%, 6.36% of US assessed joints, respectively. In the gout patients, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. Synovial lesion was related with HAG, while bone erosion was related to tophi and DCS. Conclusion HAG is the early sign of MSU crystal deposition in joints. Early urate lowering therapy (ULT) may reduce HAG and ameliorate synovitis and synovial hypertrophy. DCS and tophi are the risk factors of bone erosion. Early ULT should be considered in the gout patients with DCS or tophi.

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Combining Hyperechoic Aggregates and the Double-Contour Sign Increases the Sensitivity of Sonography for Detection of Monosodium Urate Deposits in Gout

Abstract: Hyperechoic aggregates and the double-contour sign in combination improve the investigative sensitivity of sonography than either hyperechoic aggregates or the double-contour sign individually for detecting MSU crystal deposits in gouty joints.

Cited by 10 publications

References 21 publications

Correlation between Ultrasound Findings of Uric Acid Precipitate in MTP I and Acute Gout Flare in Gouty Arthritis

Correlation between Ultrasound Findings of Uric Acid Precipitate in MTP I and Acute Gout Flare in Gouty Arthritis

Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

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