A Pilot Study on Dual-Energy Computed Tomography for Detection of Urate Deposits in Renal Transplant Patients With Asymptomatic Hyperuricemia

Kimura‐Hayama, Eric; Críales-Vera, Sergio; Nicolaou, Savvas; Betanzos, Jose L.; Rivera, Yahaira Vicencio; Alberú, Josefina; Rull-Gabayet, Marina; Hernández-Molina, Gabriela

doi:10.1097/rhu.0000000000000140

Cited by 11 publications

(9 citation statements)

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“…Kimura-Hayama et al, in 2014, studied the faster tophaceous monosodium urate crystals (MSU) deposition found that the prevalence of new-onset gout-induced tacrolimus in KTxRwas 70.4%, while it was 40.7% with CyA. They scanned 351 anatomical regions in the 27 KTxR cases with HU and identified only one patient with MSU deposition in the quadriceps tendon [ 39 ]. This finding was inconsistent with what was already known about the commonest sites for tophaceous gout MSU crystals deposition were the Achilles and the peroneal tendons [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Musculoskeletal Manifestations in Adult Kidney Transplant’s Recipients: A Systematic Review

et al. 2021

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Background and Objectives: The musculoskeletal (MSK) manifestations in the kidney transplant recipient (KTxR) could lead to decreased quality of life and increased morbidity and mortality. However, the prevalence of these MSK manifestations is still not well-recognized. This review aimed to investigate the prevalence and outcomes of MSK manifestations in KTxR in the last two decades. Materials and Methods: Research was performed in EBSCO, EMBASE, CINAHL, PubMed/MEDLINE, Cochrane, Google Scholar, PsycINFO, Scopus, Science Direct, and Web of Science electronic databases were searched during the years 2000–2020. Results: The PRISMA flow diagram revealed the search procedure and that 502 articles were retrieved from the initial search and a total of 26 articles were included for the final report in this review. Twelve studies reported bone loss, seven studies reported a bone pain syndrome (BPS) or cyclosporine-induced pain syndrome (CIPS), and seven studies reported hyperuricemia (HU) and gout. The prevalence of MSK manifestations in this review reported as follow: BPS/CIPS ranged from 0.82% to 20.7%, while bone loss ranged from 14% to 88%, and the prevalence of gout reported in three studies as 7.6%, 8.0%, and 22.37%, while HU ranged from 38% to 44.2%. Conclusions: The post-transplantation period is associated with profound MSK abnormalities of mineral metabolism and bone loss mainly caused by corticosteroid therapy, which confer an increased fracture risk. Cyclosporine (CyA) and tacrolimus were responsible for CIPS, while HU or gout was attributable to CyA. Late diagnosis or treatment of post-transplant bone disease is associated with lower quality of life among recipients

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Section: Discussionmentioning

confidence: 99%

Prevalence of Musculoskeletal Manifestations in Adult Kidney Transplant’s Recipients: A Systematic Review

et al. 2021

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“…First, while patients with long-term exposure to high sUA levels may be predisposed to having subclinical MSU crystal deposits, we were unable to examine such association given its cross-sectional study design. 9 Second, this study was based on a cohort of 46 patients with mild-to-moderately elevated levels of sUA. Although, to the best of our knowledge, this study is the largest study that evaluated DECT MSU crystal deposits among patients with asymptomatic hyperuricemia, evaluating a larger number of patients with MSU crystal deposits on DECT may further characterise factors associated with subclinical deposition of MSU crystals.…”

Section: Discussionmentioning

confidence: 99%

Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT

et al. 2018

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ObjectivesDual-energy CT (DECT) scan is a sensitive and specific tool used to visualise and quantify monosodium urate (MSU) crystal deposits in the joints. Few studies have examined MSU crystal deposits in patients with asymptomatic hyperuricemia (ie, hyperuricemia in the absence of gout) using DECT.MethodsWe conducted a prospective, non-interventional cross-sectional study to detect MSU crystal deposits on DECT scans among patients with asymptomatic hyperuricemia. We also examined patient factors associated with subclinical MSU crystal deposits. Out of 130 subjects aged ≥40 years with metabolic syndrome screened for serum uric acid (sUA) levels ≥6.5 mg/dL, 46 underwent a foot/ankle DECT scan.ResultsThe mean age of the study participants was 62 (±8) years, 41% were men and the mean sUA level was 7.8 (±1.0) mg/dL. Seven (15%) of 46 patients had MSU crystal deposits on DECT with a mean total volume of 0.13 (±0.14) cm3. In the univariable logistic regression analysis, older age had a significant association with presence of MSU crystal deposits (OR 1.20, 95% CI 1.03 to 1.39), but sUA did not (OR 1.36, 95% CI 0.63 to 2.95). In the univariable analysis, sUA levels showed a trend towards a modest linear association (β=0.11, P=0.09) with total volume of MSU crystal deposits.ConclusionsFifteen per cent of patients with asymptomatic hyperuricemia had subclinical MSU crystal deposits on foot/ankle DECT scans. Older age, but not sUA, was significantly associated with presence of subclinical MSU crystal deposits among patients with asymptomatic hyperuricemia. Clinical significance of these subclinical MSU crystal deposits needs to be determined.

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“…First, we may have included patients with a shorter duration of gout or a lesser degree of hyperuricemia, leading to MSU crystal deposition below the threshold of detection of DECT. The reported sensitivity of DECT for the detection of MSU deposits is proportional to the stage of gout, being 0.03-24 % in asymptomatic hyperuricemia [ 13 , 15 ], 79–80 % in patients with short-duration acute gout [ 12 , 13 ], 84 % in long-duration (≥3 years) acute gout [ 13 ] and 100 % in tophaceous gout [ 7 – 9 ]. The limit of detection of DECT is generally considered to be 2 mm, so microscopic tophi may be missed [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout

Baer

Kurano

Thakur

et al. 2016

BMC Musculoskelet Disord

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BackgroundDual-energy computed tomography (DECT) is a new diagnostic tool for gout, but its sensitivity has not been established. Our goal was to assess the sensitivity of DECT for the detection of monosodium urate (MSU) deposits in non-tophaceous and tophaceous gout, both at the level of the patient and that of the individual joint or lesion.MethodsDECT was performed on 11 patients with crystal-proven non-tophaceous gout and 10 with tophaceous gout and included both the upper and lower extremities in 20/21 patients. DECT images were simultaneously acquired at 80 and 140 kV and then processed on a workstation with proprietary software using a two-material decomposition algorithm. MSU deposits were color coded as green by the software and fused onto grey-scale CT images. The number and location of these deposits was tallied independently by two DECT-trained radiologists blinded to the clinical characteristics of the patient. Sensitivity of DECT was defined as the proportion of patients with a confirmed diagnosis of gout which was correctly identified as such by the imaging technique. All patients provided informed consent to participate in this IRB-approved study.ResultsMSU deposits were detected by DECT in ≥1 joint area in 7/11 (64 %) patients with non-tophaceous gout, but were only detected in 3/12 (25 %) joints proven by aspiration to be affected with gout. Inclusion of the upper extremity joints in the scanning protocol did not improve sensitivity. All 10 patients with tophaceous gout had MSU deposits evident by DECT. The sensitivity of DECT for individual gouty erosions was assessed in 3 patients with extensive foot involvement. MSU deposits were detected by DECT within or immediately adjacent to 13/26 (50 %) erosions.ConclusionsA DECT protocol that includes all lower extremity joints has moderate sensitivity in non-tophaceous and high sensitivity in tophaceous gout. However, DECT has lower sensitivity when restricted to individual crystal-proven gouty joints in non-tophaceous disease or individual erosive lesions in tophaceous gout. The detection of MSU deposits by DECT relates to their size and density and the detection parameters of the DECT scanner and adjustment of the latter might improve sensitivity.

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A Pilot Study on Dual-Energy Computed Tomography for Detection of Urate Deposits in Renal Transplant Patients With Asymptomatic Hyperuricemia

Cited by 11 publications

References 11 publications

Prevalence of Musculoskeletal Manifestations in Adult Kidney Transplant’s Recipients: A Systematic Review

Prevalence of Musculoskeletal Manifestations in Adult Kidney Transplant’s Recipients: A Systematic Review

Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT

Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout

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