Dual energy computed tomography: a novel technique for diagnosis of gout

Ahmad, Zohra; Gupta, Arun Kumar; Sharma, Raju; Bhalla, Ashu Seith; Kumar, Uma; Sreenivas, V.

doi:10.1111/1756-185x.12874

Cited by 20 publications

(20 citation statements)

References 21 publications

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“…Most previous studies have not focused on the properties of colour-coded DECT lesions, but rather on the diagnostic accuracy of DECT scans in predicting gout at a patient level. Several studies have evaluated the specificity of colour-coded DECT lesions using either MSU microscopy [10][11][12][13][14] or other criteria as reference standards (e.g. physician evaluated diagnosis, ACR 1977 gout classification criteria) [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Dual-energy CT in gout patients: Do all colour-coded lesions actually represent monosodium urate crystals?

et al. 2020

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Background Dual-energy CT (DECT) can acknowledge differences in tissue compositions and can colour-code tissues with specific features including monosodium urate (MSU) crystals. However, when evaluating gout patients, DECT frequently colour-codes material not truly representing MSU crystals and this might lead to misinterpretations. The characteristics of and variations in properties of colour-coded DECT lesions in gout patients have not yet been systematically investigated. The objective of this study was to evaluate the properties and locations of colour-coded DECT lesions in gout patients. Methods DECT of the hands, knees and feet were performed in patients with suspected gout using factory default gout settings, and colour-coded DECT lesions were registered. For each lesion, properties [mean density (mean of Hounsfield Units (HU) at 80 kV and Sn150kV), mean DECT ratio and size] and location were determined. Subgroup analysis was performed post hoc evaluating differences in locations of lesions when divided into definite MSU depositions and possibly other lesions. Results In total, 4033 lesions were registered in 27 patients (23 gout patients, 3918 lesions; 4 non-gout patients, 115 lesions). In gout patients, lesions had a median density of 160.6 HU and median size of 6 voxels, and DECT ratios showed an approximated normal distribution (mean 1.06, SD 0.10), but with a right heavy tail consistent with the presence of smaller amounts of high effective atomic number lesions (e.g. calcium-containing lesions). The most common locations of lesions were 1st metatarsophalangeal (MTP1), knee and midtarsal joints along with quadriceps and patella tendons. Subgroup analyses showed that definite MSU depositions (large volume, low DECT ratio, high density) had a similar distribution pattern, whereas possible calcium-containing material (high DECT ratio) and non-gout MSU-imitating lesions (properties as definite MSU depositions in non-gout patients) were primarily found in some larger joints (knee, midtarsal and talocrural) and tendons (Achilles and quadriceps). MTP1 joints and patella tendons showed only definite MSU depositions. Conclusion Colour-coded DECT lesions in gout patients showed heterogeneity in properties and distribution. MTP1 joints and patella tendons exclusively showed definite MSU depositions. Hence, a sole focus on these regions in the evaluation of gout patients may improve the specificity of DECT scans.

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Section: Discussionmentioning

confidence: 99%

Dual-energy CT in gout patients: Do all colour-coded lesions actually represent monosodium urate crystals?

et al. 2020

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“…Diagnosis of gout, clinical classification criteria only98–101; MSU crystal identification only40 50 103 104; clinical criteria and/or MSU crystal identification 49 77*Pooled data from: 50 103 104 †50 77 98–101 103 104 DECT, dual-energy CT; MA, meta-analysis; MSU, monosodium urate; NA, not applicable.…”

Section: Recommendationsmentioning

confidence: 99%

“…Diagnosis of gout, clinical classification criteria only98–101; MSU crystal identification only40 50 103 104; clinical criteria and/or MSU crystal identification 49 77…”

Section: Recommendationsmentioning

confidence: 99%

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

et al. 2019

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Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.

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“…The advent of DECT now allows noninvasive diagnosis of gout. 54 Performing a CT scan at two different energy levels allows material-specific differences in attenuation between the acquisitions, enabling classification of the chemical composition of the scanned tissues, and specific characterization and separation of gout deposits from the surrounding tissue. 12 When gout affects the hip, there may be a joint effusion with synovitis.…”

Section: Crystal Diseasementioning

confidence: 99%

Hip Inflammatory Conditions: A Practical Differential Diagnosis Algorithmic Approach in Adults and Children

Jaremko

Teh

Weidekamm

et al. 2019

Semin Musculoskelet Radiol

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The child or adult patient presenting with acute hip pain in the absence of major trauma often presents a difficult diagnostic dilemma, due to the complex anatomy and diversity of pathology at the hip. A correct diagnosis is important because untreated hip inflammatory disease can lead to lifelong morbidity from structural damage at this weightbearing joint. An effective and efficient process of reaching an appropriate diagnosis often requires multiple imaging modalities overseen by careful clinical judgment. This article reviews an algorithmic approach to imaging the acutely painful hip, with attention to uses and limitations of each imaging modality, and it offers details on the key differential diagnoses in adults and children.

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Dual energy computed tomography: a novel technique for diagnosis of gout

Cited by 20 publications

References 21 publications

Dual-energy CT in gout patients: Do all colour-coded lesions actually represent monosodium urate crystals?

Dual-energy CT in gout patients: Do all colour-coded lesions actually represent monosodium urate crystals?

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

Hip Inflammatory Conditions: A Practical Differential Diagnosis Algorithmic Approach in Adults and Children

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