Gout of feet and ankles in different disease durations: diagnostic value of single-source DECT and evaluation of urate deposition with a novel semi-quantitative DECT scoring system

Abstract

Objectives To investigate the diagnostic performance of single-source dual-energy computed tomography (DECT) based on gemstone spectral imaging technology (including Discovery CT750HD and Revolution CT) in patients with suspected feet/ankles gouty arthritis, and evaluate the urate deposition with a novel semi-quantitative DECT scoring system. Methods A total of 196 patients were consecutively included. Feet and ankles were evaluated in all patients by single-source DECT scan. The 2015 EULAR/ACR criteria were used as the reference for the diagnosis of gout. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of DECT for the diagnosis of gout in the early (≤1 year), middle (1–3 years), and late (> 3 years) disease durations were calculated. Besides, a novel semi-quantitative DECT scoring system was assessed for the measurement of urate deposition, and the correlation between the scores and the clinical and serological data were also evaluated. Moreover, the influences of artifacts on the diagnostic performance of DECT were also determined. Results The sensitivity, specificity, and AUC of DECT in 196 patients were 38.10, 96.43%, and 0.673 in the early-stage group; 62.96, 100.00%, and 0.815 in the middle-stage group; and 77.55, 87.50%, and 0.825 in the late-stage group, respectively. The overall diagnostic accuracies in the AUC of DECT (Discovery CT750HD and Revolution CT) in the middle and late stages of gout were higher than that in the early stage of gout. Besides, the monosodium urate crystals were deposited on the first metatarsophalangeal joints and ankles/midfeet. Age, the presence of tophus, bone erosion, and disease duration considerably affected the total urate score. No statistical difference in the positive detection of nail artifact, skin artifact, vascular calcification, and noise artifact was found between the case and control groups. Conclusion DECT (Discovery CT750HD and Revolution CT) showed promising diagnostic accuracy for the detection of urate crystal deposition in gout but had limited diagnostic sensitivity for short-stage gout. Longer disease duration, the presence of tophus, and bone erosion were associated with the urate crystal score system. The artifacts do not remarkably affect the diagnostic performance of DECT in gout.

Dual-energy computed tomography in crystalline arthritis: knowns and unknowns

“…However, in early disease (symptom duration <1 or 2 years), DECT sensitivity may be insufficient, owing to a spatial resolution of several hundred microns at best, precluding detection of small deposits. A recent cohort study of 196 patients compared the diagnostic performance of DECT alone according to disease duration [14]. DECT demonstrated poor sensitivity (38%) in very early disease (<1 year), a situation where ultrasound usually displays better performance.…”

Gout of feet and ankles in different stages: The potentiality of a new semiquantitative DECT scoring system in monitoring urate deposition

“…While DECT has been increasingly used in the detection and volume assessment of MSU crystals in patients with gout, only 2 studies have applied this scoring system to evaluate urate deposition in these patients. [ 15 ]…”

Detailed analysis of the association between urate deposition and bone erosion in gout: a dual-energy computed tomography study

“…Bone erosion is a strong predictor of musculoskeletal disability in gout (15); therefore, early detection and assessment are critical in reducing the risk of joint functional disability. Over the past decade, radiology has been used to investigate the relationship between MSU crystals and bone erosion (16)(17)(18)(19). Jin et al (18) employed a novel semi-quantitative DECT scoring system to assess urate deposition (UD) and demonstrate that total urate was associated with bone erosion.…”

“…Over the past decade, radiology has been used to investigate the relationship between MSU crystals and bone erosion (16)(17)(18)(19). Jin et al (18) employed a novel semi-quantitative DECT scoring system to assess urate deposition (UD) and demonstrate that total urate was associated with bone erosion. Mark et al ( 16) utilized a plain radiographerosion score and urate volume from DECT to demonstrate that tophus urate was directly associated with erosion.…”

“…Jin et al. ( 18 ) employed a novel semi-quantitative DECT scoring system to assess urate deposition (UD) and demonstrate that total urate was associated with bone erosion. Mark et al.…”