The Role of Dual-Energy Computed Tomography in Musculoskeletal Imaging

Fukuda, Takeshi; Fukuda, Kunihiko

doi:10.1016/j.cpet.2018.05.009

Cited by 9 publications

(4 citation statements)

References 82 publications

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“…MRI typically shows a low-to-moderate signal on T1-weighted images and a more variable, moderate-to-high signal on T2-weighted images, which may be difficult to distinguish from malignancy. Recently, dual-energy CT, which uses X-rays with two different levels of energy, has been reported to be useful for discriminating between uric acid crystals and bone and calcified lesions [6,7]. In our third case, it was difficult to detect the gout nodule by MRI, and the diagnosis was made by dual-energy CT.…”

Section: Discussionmentioning

confidence: 74%

Three Cases of Gouty Tophus in the Foot Treated by Resection

Shioazaki¹,

Kimura²,

Saito³

et al. 2023

Cureus

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We encountered three cases of gouty tophus in the foot that required resection. All patients were male and aged 44-68 years at the time of surgery. The lesions were located on the great toe, second toe, and lateral malleolus and were causing ulceration and destruction of the joints. One patient had normal uric acid levels, and another patient had hyperuricemia but no history of attacks and no significant inflammatory symptoms around the gouty tophus, which was attributed to the physical containment of uric acid crystals by the gouty tophus. Given that the crystals were adherent to the surrounding fibrous tissue and cartilage surface, we resected them as far as possible to reduce the total amount of crystals and treated the remaining crystals with uric acid-lowering therapy. There were no complications at the time of surgery. The swelling and bone destruction subsided with continued medical treatment, resulting in significant improvement in quality of life. Patients with gouty tophus should be treated aggressively with medication and monitored to prevent severe joint destruction and ulceration. Excision of the nodule should be considered in cases of exacerbation.

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Section: Discussionmentioning

confidence: 74%

Three Cases of Gouty Tophus in the Foot Treated by Resection

Shioazaki¹,

Kimura²,

Saito³

et al. 2023

Cureus

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“…That is why we used DECT. This imaging modality obtains two exposures at different energy levels, which allows material decomposition and acquisition of virtual monochromatic images [ 5 ]. The discriminated materials can be color-coded and overlaid onto CT images to aid diagnosis and localization of a lesion.…”

Section: Discussionmentioning

confidence: 99%

Gouty Tophus in the Foot without Hyperuricemia Diagnosed by Dual-energy Computed Tomography: A Case Report

Kimura¹,

Kubota²,

Hattori³

et al. 2021

JOCR

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Introduction: Gouty tophi are relatively simple to diagnose because they almost always occur in patients with persistent hyperuricemia. Treatment typically consists mainly of oral medication, and surgical intervention is necessary for only a small number of patients. Case Presentation: We present a case of 66-year-old Japanese man presented with a painful gouty tophus diagnosed by dual-energy computed tomography in the right foot without hyperuricemia that had gradually increased in size over the past 20 years. The tophus was removed and the patient’s plantar pain disappeared after surgery and there was no recurrence. Conclusion: We obtained a favorable outcome through surgical intervention for a gouty tophus of the foot diagnosed by dual-energy computed tomography in a patient without hyperuricemia. Our experience suggests that proactive surgical removal of gouty tophi should be considered for symptomatic cases and to prevent further joint destruction. Keywords:Dual-energy computed tomography, foot, gouty tophus.

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“…Additionally, they showed that BME detection both in the appendicular skeleton and the spine has a very good diagnostic performance, with sensitivity and specificity of 84% and 93%, respectively, for appendicular bones, and 84% and 98% for the spine. BME detection is also helpful in nontraumatic cases such as the hands in acute inflammatory arthritis, 19,20 BME in sacroiliitis, 21 osteoporotic vertebral compression fracture, 2,22,23 osteomyelitis, and bone tumors. 3,24 In any oncologic imaging center, differentiating between osseous metastatic disease and benign osseous lesions is a common dilemma.…”

Section: Virtual Non-calcium Imagesmentioning

confidence: 99%

Top-Ten Tips for Dual-Energy CT in MSK Radiology

Walstra

Hickle

Duggan

et al. 2019

Semin Musculoskelet Radiol

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Dual-energy computed tomography (DECT) has the potential to detect musculoskeletal pathology with greater sensitivity than conventional CT alone at no additional radiation dose to the patient. It therefore has the potential to reduce the need for further diagnostic imaging or procedures (e.g., joint aspirations in the case of gout or magnetic resonance imaging to confirm undisplaced fractures).DECT is a well-established technique for the detection of gout arthropathy. Multiple newer applications have shown clinical potential including bone marrow edema detection and metal artifact reduction. Collagen analysis, bone marrow lesion detection, and iodine mapping in CT arthrography are areas of possible future application and development.This article outlines 10 tips on the use of DECT imaging of the musculoskeletal system, explaining the technique and indications with practical suggestions to help guide the radiologist.

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The Role of Dual-Energy Computed Tomography in Musculoskeletal Imaging

Cited by 9 publications

References 82 publications

Three Cases of Gouty Tophus in the Foot Treated by Resection

Three Cases of Gouty Tophus in the Foot Treated by Resection

Gouty Tophus in the Foot without Hyperuricemia Diagnosed by Dual-energy Computed Tomography: A Case Report

Top-Ten Tips for Dual-Energy CT in MSK Radiology

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