Detection of Lumbar Facet Joint Gouty Arthritis Using Dual-energy Computed Tomography

Parikh, Pragnesh; Butendieck, Ronald R.; Kransdorf, Mark J.; Calamia, Kenneth

doi:10.3899/jrheum.100492

Cited by 20 publications

(9 citation statements)

References 10 publications

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“…Additionally, gout can affect joint areas which were not part of our study, or were only represented in very low numbers, such as the spine, the shoulders and the elbows. 16 Therefore, the performance of DECT for these joint areas is unclear and images should be interpreted with caution. Interestingly, in several patients with an unremarkable SF analysis, DECT did demonstrate evidence of MSU deposition in tendon sheaths and entheseal sites.…”

Section: Discussionmentioning

confidence: 99%

Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study

et al. 2014

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ObjectivesTo assess the accuracy of dual-energy CT (DECT) for diagnosing gout, and to explore whether it can have any impact on clinical decision making beyond the established diagnostic approach using polarising microscopy of synovial fluid (diagnostic yield).MethodsDiagnostic single-centre study of 40 patients with active gout, and 41 individuals with other types of joint disease. Sensitivity and specificity of DECT for diagnosing gout was calculated against a combined reference standard (polarising and electron microscopy of synovial fluid). To explore the diagnostic yield of DECT scanning, a third cohort was assembled consisting of patients with inflammatory arthritis and risk factors for gout who had negative synovial fluid polarising microscopy results. Among these patients, the proportion of subjects with DECT findings indicating a diagnosis of gout was assessed.ResultsThe sensitivity and specificity of DECT for diagnosing gout was 0.90 (95% CI 0.76 to 0.97) and 0.83 (95% CI 0.68 to 0.93), respectively. All false negative patients were observed among patients with acute, recent-onset gout. All false positive patients had advanced knee osteoarthritis. DECT in the diagnostic yield cohort revealed evidence of uric acid deposition in 14 out of 30 patients (46.7%).ConclusionsDECT provides good diagnostic accuracy for detection of monosodium urate (MSU) deposits in patients with gout. However, sensitivity is lower in patients with recent-onset disease. DECT has a significant impact on clinical decision making when gout is suspected, but polarising microscopy of synovial fluid fails to demonstrate the presence of MSU crystals.

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Section: Discussionmentioning

confidence: 99%

Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study

et al. 2014

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“…DECT can differentiate different materials based on their relative absorption of X-rays at different photon energy levels (25,27). There are currently a few promising cases of using DECT in the work up of spinal gout patients (26,28,29). In the absence of DECT, Hou et al presents an algorithm that helps in the diagnosis and management of presumed spinal gout (2).…”

Section: Discussionmentioning

confidence: 99%

Tophaceous gout of the cervical and thoracic spine with concomitant epidural infection

Cheng¹,

Nguyen²,

Zhou³

2018

AME Case Rep.

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Tophaceous gout of the spine is an underappreciated source of back pain in patients with or without neurological decline. It has been reported to occur in the cervical, thoracic and lumbar spine. Rarely, does it occur at more than one region of the spine. Advanced imaging with magnetic resonance imaging and computed tomography are usually not helpful in differentiating between infection, malignancy and gout. Clinician should have a high suspicion of spinal gout in patients with history of gout who presents with renal insufficiency, presence of peripheral tophi on exam, with elevated serum uric acid and creatinine levels, erythrocyte sedimentation rate and C-reactive protein. Here we present a case of a 23-year-old male with history of gout and chronic renal disease with progressive weakness in his lower extremities with new urinary incontinence who was found to have spinal gout with epidural infection of both the cervical and thoracic spine. Our patient was successfully managed with surgical decompression followed by medical treatment with antibiotics and steroids.

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“…Excellent agreement was observed between DECT readers (k ¼ 0.87; range 0.70-1.00). Although DECT has been used mainly to image peripheral sites, this method can also detect urate deposits centrally, at sites such as the spine [16]. Although this method holds great promise in providing specific images in gout, a number of uncertainties remain.…”

Section: Key Pointsmentioning

confidence: 99%

Imaging in gout

Dalbeth

Doyle²,

McQueen³

2012

Current Opinion in Rheumatology

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Detection of Lumbar Facet Joint Gouty Arthritis Using Dual-energy Computed Tomography

Cited by 20 publications

References 10 publications

Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study

Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study

Tophaceous gout of the cervical and thoracic spine with concomitant epidural infection

Imaging in gout

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