Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value?

Ziegeler, Katharina; Hermann, Sandra; Hermann, Kai; Hamm, Bernd; Diekhoff, Torsten

doi:10.1007/s00256-019-03343-5

Cited by 18 publications

(18 citation statements)

References 19 publications

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“…In gout patients, the median size of an MSU deposit is 6 pixels (corresponding to a CSA of 0.735–2.16 mm 2 depending on body region and pixel size) 16 ; combined with our finding, we thus expect the excellent differentiation of MSU and calcium-containing crystals to apply in vivo. The clinical use of this ability remains to be proved: a clinical study of gout and CPP crystals at the wrist found no added value of DECT compared with conventional CT in improving diagnosis, 12 but the study was retrospective with virtual reconstruction of conventional CT based on DECT scans, color-coded DECT image analysis, and a selected study population of known gout or CPPD and results should ideally be reproduced prospectively in a randomized setting.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Calcium pyrophosphate (CPP) crystal deposits are a well-known cause for pseudogout/acute CPP crystal arthritis, and both CPP and calcium hydroxyapatite (HA) crystal deposits are suspected to play a pathological role in osteoarthritis (OA). [4][5][6][7][8][9] The ability of DECT to detect and differentiate MSU and CPP crystal deposits has been explored, [10][11][12] but the ability to identify HA crystal deposits has not yet been explored in vivo. Because the small size of HA crystal deposits (individual crystals, 20-100 nm; aggregates, 5-20 μm), they cannot be recognized by conventional polarized light microscopy, 13 and DECT could prove valuable for the noninvasive detection and characterization of crystal aggregates.…”

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confidence: 99%

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Dual-Energy Computed Tomography for Detection and Characterization of Monosodium Urate, Calcium Pyrophosphate, and Hydroxyapatite

et al. 2021

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Objectives: The aim of this study was to determine the diagnostic performance of dual-energy computed tomography (DECT) to detect and distinguish crystal deposits in a phantom. The primary objective was to determine the cutoff DECT ratio and the cross-sectional area (CSA) of a crystal deposit necessary to differentiate monosodium urate (MSU), calcium pyrophosphate (CPP), and calcium hydroxyapatite (HA) using DECT. Our secondary objective was to determine the concentration for limit of detection for MSU, CPP, and HA crystal deposits. Exploratory objectives included the comparison between 2 generations of DECT scanners from the same manufacturer as well as different scanner settings. Materials and Methods: We used a cylindrical soft tissue phantom with synthetic MSU, CPP, and HA crystals suspended in resin. Crystal suspension concentration increased with similar attenuation between MSU, CPP, and HA in conventional CT. The phantom was scanned on 2 dual-source DECT scanners, at 2 dose levels and all available tube voltage combinations. Both scanners had a tin (Sn) filter at the high-energy spectra. Dual-energy CT ratios were calculated for a given tube voltage combination by dividing linear regression lines of CT numbers against concentration. Dual-energy CT ratios were compared using an analysis of covariance. Receiver operating characteristic curves and corresponding areas under the curve (AUCs) were calculated for individual crystal suspension comparisons (HA vs CPP, MSU vs CPP, and MSU vs HA). Results: At standard clinical scan settings with 8 mGy and 80/Sn150 kV, the DECT ratios were as follows: CPP, 2.02 (95% confidence interval [CI], 1.98-2.07); HA, 2.00 (95% CI, 1.96-2.05); and MSU, 1.09 (95% CI, 1.06-1.11). Ratios varied numerically depending on the scanner and tube voltage combination. Monosodium urate crystal DECT ratios were significantly different from HA and CPP (P < 0.001), whereas DECT ratios for HA and CPP crystals did not differ significantly (P = 0.99). The differentiation of MSU crystals from both calcium crystals (HA and CPP) was excellent with an AUC of 1.00 (95% CI, 1.00-1.00) and an optimal cutoff DECT ratio of 1.43:1.40 depending on the scanner. In addition, differentiation of MSU and calcium-containing crystals (HA and CPP) required a CSA of minimum 4 pixels of crystal at standard clinical scan conditions. In contrast, differentiation between CPP and HA crystals was moderate with AUCs ranging from 0.66 (95% CI, 0.52-0.80) to 0.80 (95% CI, 0.69-0.91) and an optimal cutoff DECT ratio of 2.02:2.06 depending on the scanner. Furthermore, differentiation between CPP and HA crystals required a CSA of minimum 87 pixels of crystal at standard clinical scan conditions, corresponding to a region of interest of 3.7 mm diameter. When scanning at highest possible spectral separation and maximum dose of 50 mGy, the limit of detection for crystals within a region of interest of 50 pixels was 14 mg/cm 3 for MSU and 2 mg/cm 3 for both CPP and HA. Conclusions: This phantom study shows that DECT can be used to ...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Dual-Energy Computed Tomography for Detection and Characterization of Monosodium Urate, Calcium Pyrophosphate, and Hydroxyapatite

et al. 2021

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“…Furthermore, one can ask whether we have used the best imaging method to detect crystals, since promising studies about the use of ultrasound37 in the identification of CPPD have been published while the significance of DECT seems less clear 38 39. In this study we have not systematically used ultrasound to detect crystals in hand or feet due to lack of standardisation.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of chondrocalcinosis and frequent comorbidity with calcium pyrophosphate deposition disease in patients with seronegative rheumatoid arthritis

et al. 2022

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BackgroundThe crystal-induced calcium pyrophosphate deposition disease (CPPD) clinically appearing as pseudogout differs from the mere radiographic finding of chondrocalcinosis (CC) but may cause symptoms resembling rheumatoid arthritis (RA).ObjectiveTo study the prevalence of CPPD and CC in rheumatic diseases focusing on differences between seropositive and seronegative RA.Patients and methodsIn a retrospective study design, we analysed records and radiographs of consecutive new patients presenting to our centre between January 2017 and May 2020. 503 patients were identified based on expert diagnoses: 181 with CPPD, 262 with RA, 142 seropositive (54.2%) and 120 seronegative RA, gout (n=30) and polymyalgia rheumatica (n=30), mean symptom duration <1 year in almost all patients.ResultsThe majority of patients had only one rheumatological diagnosis (86.9%). Most patients with CPPD (92.6%) had radiographic CC, primarily in the wrists. The prevalence of CC was higher in seronegative (32.3%) than in seropositive RA (16.6%), respectively (p<0.001). Patients with CPPD were older (p<0.001) and had acute attacks more frequently than patients with RA (p<0.001), who had symmetric arthritis more often (p=0.007). The distribution pattern of osteoarthritic changes in radiographs of hands and wrists differs between patients with RA and CPPD. CC was present in more than one joint in 73.3% of patients with CPPD, 9.6% with seropositive and 18.7% with seronegative RA.DiscussionCPPD and CC were more frequent in seronegative versus seropositive RA. Symmetry of arthritis and acuteness of attacks differentiated best between CPPD and RA but localisation of joint involvement did not. Co-occurrence of both diseases was frequently observed.

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“…16 The sensitivity of DECT in detecting pseudogout is thus lower than that for gout detection because it is a diagnosis of exclusion. 16,17 Other application of DECT around the knee include bone marrow imaging. 16 By using virtual non-calcium (VNCa) reconstructions, DECT can detect nontraumatic bone marrow edema (BME) of the hip and knee with high sensitivity and specificity.…”

Section: Dual-energy Computed Tomographymentioning

confidence: 99%

Advanced Imaging of Gout and Other Inflammatory Diseases Around the Knee

Sudoł-Szopińska,

Lanckoroński,

Teh

et al. 2024

Semin Musculoskelet Radiol

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The knee is one of the most commonly affected joints in the course of inflammatory arthropathies, such as crystal-induced and autoimmune inflammatory arthritis. The latter group includes systemic connective tissue diseases and spondyloarthropathies. The different pathogenesis of these entities results in their varied radiologic images. Some lead quickly to joint destruction, others only after many years, and in the remaining, destruction will not be a distinguishing radiologic feature.Radiography, ultrasonography, and magnetic resonance imaging have traditionally been the primary modalities in the diagnosis of noninflammatory and inflammatory arthropathies. In the case of crystallopathies, dual-energy computed tomography has been introduced. Hybrid techniques also offer new diagnostic opportunities. In this article, we discuss the pathologic findings and imaging correlations for crystallopathies and inflammatory diseases of the knee, with an emphasis on recent advances in their imaging diagnosis.

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Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value?

Cited by 18 publications

References 19 publications

Dual-Energy Computed Tomography for Detection and Characterization of Monosodium Urate, Calcium Pyrophosphate, and Hydroxyapatite

Dual-Energy Computed Tomography for Detection and Characterization of Monosodium Urate, Calcium Pyrophosphate, and Hydroxyapatite

High prevalence of chondrocalcinosis and frequent comorbidity with calcium pyrophosphate deposition disease in patients with seronegative rheumatoid arthritis

Advanced Imaging of Gout and Other Inflammatory Diseases Around the Knee

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