Detection of uric acid depositing in tophaceous gout using a new dual energy spectral CT technology

Xiao-hu, LI; Wang, Xu; Yu, Yonqqiang; Liu, Bin; Cai, Jing; Li, Xia; Li, Luo; Wang, Wanqin; Ding, Qianyun; Zhang, Chao; Wang, Jie

doi:10.3233/xst-140444

Cited by 7 publications

(7 citation statements)

References 11 publications

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“…The DECT GSI method has been methodically tested and shown to be able to detect MSU deposits by Li et al 2014 [12]. Kiefer et al compared single source DECT with conventional CT and digital radiography and showed that it had the best diagnostic properties of the three for gout diagnosis [13].…”

Section: Discussionmentioning

confidence: 99%

Dual energy CT findings in gout with rapid kilovoltage-switching source with gemstone scintillator detector

et al. 2020

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Background: A definite diagnosis of gout requires demonstration of monosodium urate crystals in synovial fluid or in tophi, which in clinical practice today seldom is done. Dual energy CT (DECT) has repeatedly been shown to be able to detect monosodium urate crystals in tissues, hence being an alternative method to synovial fluid microscopy. The vast majority of these studies were performed with CT scanners with two X-ray tubes. In the present study we aim to investigate if and at what locations DECT with rapid kilovoltage-switching source with gemstone scintillator detector (GSI) can identify MSU crystals in patients with clinically diagnosed gout. We also performed a reliability study between two independent readings. Methods: Patients with new or established gout who had been examined with DECT GSI scanning of the feet at Sahlgrenska University Hospital, Mölndal between 2015 and 2018 were identified. Their medical records were sought for gout disease characteristics using a structured protocol. Urate deposits in MTP1, MTP 2-5, ankle/midfoot joints and tendons were scored semiquantatively in both feet and presence of artifacts in nail and skin as well as beam hardening and noise were recorded. Two radiologists performed two combined readings and scoring of the images, thus consensus was reached over the scoring at each occasion (Espeland et al., BMC Med Imaging. 2013;13: 4). The two readings were compared with kappa statistics. Results: DECT GSI could identify urate deposits in the feet of all 55 participants with gout. Deposits were identified in the MTP-joints of all subjects but were also present in ankle/midfoot joints and tendons in 96 and 75% respectively. Deposition of urate was predicted by longer disease duration (Spearman's Rho 0.64, p < .0001) and presence of tophi (p = 0.0005). Artifacts were common and mostly found in the nails (73%), a minority displayed skin artifacts (31%) while beam hardening and noise was rare. The agreement between the two readings was good (Κ = 0.66, 95% CI = 0.61-0.71). Conclusion: The validity of DECT GSI in gout is supported by the identification of urate in all patients with clinical gout and the good correlations with clinical characteristics. The occurrence of artifacts was relatively low with expected locations.

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Section: Discussionmentioning

confidence: 99%

Dual energy CT findings in gout with rapid kilovoltage-switching source with gemstone scintillator detector

et al. 2020

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“…DECT GSI translated two sets of absorption projection data to material density projection data and provided different base material mapping (such as uric acid/calcium pairing, water/iodine pairing, water/calcium pairing, etc.). Base material concentration imaging can better reflect the content of the corresponding components of the tissue, and the uric acid crystal can be visualized more accurately in the uric acid-based map than that in the calcium-based map [19].…”

Section: Dect Examinationmentioning

confidence: 99%

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

Shang

Xiao-hu

et al. 2021

Adv Rheumatol

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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.

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“…Urate‐based material images can detect high urate concentration deposits but cannot detect other types of high concentration crystal deposits. Therefore, spectrum CT‐based material image results and pathology results have good consistency . Dong et al .…”

Section: Diagnosismentioning

confidence: 84%

“…Using the GE Healthcare AW 4.4 workstation and gemstone‐spectral imaging with base material (urate and calcium) mapping, tophi can be detected with urate‐based and calcium‐based images and this clearly shows the bone destruction and condition of tophi adjacent to joints . Li et al .…”

Section: Diagnosismentioning

confidence: 99%

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Gouty arthropathy: Review of clinico‐pathologic and imaging features

et al. 2015

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Gout is a common inflammatory arthropathy in adults, with the prevalence increasing in males of older age. It occurs when monosodium urate (MSU) crystals are deposited in joints and connective tissue causing inflammation. The gold standard for the diagnosis of gout is the demonstration of negatively birefringent, needle-shaped MSU crystals through synovial fluid aspiration. However, this is an invasive technique and may not always be conclusive or feasible. Imaging techniques have been developed to aid in diagnosis of gout non-invasively. Radiography has a low utility in the early diagnosis of gout and demonstrates erosions in late stages. Ultrasound (US) has a high overall sensitivity in diagnosing gout with the 'double contour' sign having a high specificity. Magnetic resonance imaging is good at detecting tophi, bone marrow oedema and erosions, but has a limited role in diagnosis because of its high cost and limited availability. Conventional computed tomography (CT) has no role in the routine diagnosis of gout before development of erosions and tophi. A newer technology, dual-energy CT (DECT) has been shown to be able to detect MSU crystals burden with high accuracy. It has a higher specificity and lower sensitivity that US in gout diagnosis. However, because of radiation exposure and cost, it has a better utility in diagnosing clinically suspected gout complicated by other concurrent rheumatologic conditions or if radiography, US and synovial aspiration are inconclusive or not feasible. This paper will review the clinico-pathologic and imaging features of gouty arthropathy.

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Detection of uric acid depositing in tophaceous gout using a new dual energy spectral CT technology

Cited by 7 publications

References 11 publications

Dual energy CT findings in gout with rapid kilovoltage-switching source with gemstone scintillator detector

Dual energy CT findings in gout with rapid kilovoltage-switching source with gemstone scintillator detector

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

Gouty arthropathy: Review of clinico‐pathologic and imaging features

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