Development and validation of a quantitative method for estimation of the urate burden in patients with gouty arthritis using dual-energy computed tomography

Kotlyarov, Maximilian; Hermann, Kay-Geert A.; Mews, Jürgen; Hamm, Bernd; Diekhoff, Torsten

doi:10.1007/s00330-019-06350-1

Cited by 9 publications

(7 citation statements)

References 34 publications

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“…55 Recently, dual-energy computed tomography has helped to identify urate crystals in tissues, such as coronary and aortic arteries. [56][57][58] These findings are consistent with our results and suggest that UA may be present in the atherosclerotic vasculature. However, their significance remains to be determined.…”

Section: Ua Deposits In Symptomatic Carotid Artery Plaquessupporting

confidence: 93%

Uric Acid Expression in Carotid Atherosclerotic Plaque and Serum Uric Acid Are Associated With Cerebrovascular Events

et al. 2022

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Background: Uric acid (UA) concentration within carotid plaque and its association with cerebrovascular events have not been detected or quantified. Systemically, serum UA is a marker of inflammation and risk factor for atherosclerosis. However, its association with carotid plaque instability and stroke pathogenesis remains unclear. In patients undergoing carotid endarterectomy, we aimed to determine whether UA is present differentially in symptomatic versus asymptomatic carotid plaques and whether serum UA is associated with cerebrovascular symptoms (stroke, transient ischemic attack, or amaurosis fugax). Methods: Carotid atherosclerotic plaques were collected during carotid endarterectomy. The presence of UA was assessed using Gomori methenamine silver staining as well as anti-UA immunohistochemical staining and its quantity measured using an enzymatic colorimetric assay. Clinical information was obtained through a retrospective review of data. Results: UA was more commonly detected in symptomatic (n=23) compared with asymptomatic (n=9) carotid plaques by Gomori methenamine silver (20 [86.9%] versus 2 [22.2%]; P =0.001) and anti-UA immunohistochemistry (16 [69.5%] versus 1 [11.1%]; P =0.004). UA concentration was higher in symptomatic rather than asymptomatic plaques (25.1 [9.5] versus 17.9 [3.8] µg/g; P =0.021). Before carotid endarterectomy, serum UA levels were higher in symptomatic (n=341) compared with asymptomatic (n=146) patients (5.9 [interquartile range, 4.6–6.9] mg/dL versus 5.2 [interquartile range, 4.6–6.2] mg/dL; P =0.009). Conclusions: The current study supports a potential role of UA as a potential tissue participant and a systemic biomarker in the pathogenesis of carotid atherosclerosis. UA may provide a mechanistic explanation for plaque instability and subsequent ischemic cerebrovascular events.

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Section: Ua Deposits In Symptomatic Carotid Artery Plaquessupporting

confidence: 93%

Uric Acid Expression in Carotid Atherosclerotic Plaque and Serum Uric Acid Are Associated With Cerebrovascular Events

et al. 2022

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“…We adapted the dosage of febuxostat to 120mg/die and added kineret for 3 days, followed by canakinumab 150mg s.c. every 12 weeks. Dual energy-CT (Figure 1) of both elbows, hands, chest, knees and feets was performed, revealing a high score of 1014, 4cm 3 tophi volume = 2316, 5mg weight (C5H 3 N 4 O 3 Na; molecular weight, 190.09) [1]. To our knowledge this amount of tophi volume, measured by DECT, has never been reported in the literature before.…”

mentioning

confidence: 80%

“High Score” in a Patient with Tophaceous Gout

Rech¹,

Manger²,

Schett³

et al. 2021

austinjradiol

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A 71-year old semi-somnolent patient with 3-vessel khk, chronic heart failure III°, COPD, obesity, diabetes type II, renal insufficiency, several amputated fingers and toes during a 48-year history of chronic gout was referred to our rheumatology clinic due to suspected superinfected wound of ulcerated gouty tophi. At admission the patient was on torasemid 15mg/die, febuxostat 80mg/die, ASS 100mg/ die, sitagliptin 50mg/die since years. Laboratory studies were notable for serum uric acid level of 7.7mg per deciliter, C-reactive protein 288.5mg per liter; creatinine clearance rate of 56 ml per minute per 1.73 m2 of body-surface area. We adapted the dosage of febuxostat to 120mg/die and added kineret for 3 days, followed by canakinumab 150mg s.c. every 12 weeks. Dual energy-CT (Figure 1) of both elbows, hands, chest, knees and feets was performed, revealing a high score of 1014, 4cm3 tophi volume = 2316, 5mg weight (C5H3N4O3Na; molecular weight, 190.09) [1]. To our knowledge this amount of tophi volume, measured by DECT, has never been reported in the literature before. By adding lesinurad 200mg/d to febuxostat 120mg/ die and canakinumab 150mg every 12 weeks uric acid level and C-reactive protein decreased to 5.1mg per deciliter and 24mg per liter respectively with reduction of clinical flares over the next 9 months.

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“…The calculated sets of two VNC images at 80 and 135 keV were processed in the same way as conventional DECT scans using a two-material decomposition analysis algorithm (Dual-Energy Composition Analysis, version 6.0, Canon Medical Systems) for the detection of uric acid using clinical standard settings established in previous studies [ 7 – 12 ].…”

Section: Methodsmentioning

confidence: 99%

Virtual noncontrast images reveal gouty tophi in contrast-enhanced dual-energy CT: a phantom study

Khayata,

Diekhoff,

Mews

et al. 2024

Eur Radiol Exp

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Background Dual-energy computed tomography (DECT) is useful for detecting gouty tophi. While iodinated contrast media (ICM) might enhance the detection of monosodium urate crystals (MSU), higher iodine concentrations hamper their detection. Calculating virtual noncontrast (VNC) images might improve the detection of enhancing tophi. The aim of this study was to evaluate MSU detection with VNC images from DECT acquisitions in phantoms, compared against the results with standard DECT reconstructions. Methods A grid-like and a biophantom with 25 suspensions containing different concentrations of ICM (0 to 2%) and MSU (0 to 50%) were scanned with sequential single-source DECT using an ascending order of tube current time product at 80 kVp (16.5–220 mAs) and 135 kVp (2.75–19.25 mAs). VNC images were equivalently reconstructed at 80 and 135 kVp. Two-material decomposition analysis for MSU detection was applied for the VNC and conventional CT images. MSU detection and attenuation values were compared in both modalities. Results For 0, 0.25, 0.5, 1, and 2% ICM, the average detection indices (DIs) for all MSU concentrations (35–50%) with VNC postprocessing were respectively 25.2, 36.6, 30.9, 38.9, and 45.8% for the grid phantom scans and 11.7, 9.4, 5.5, 24.0, and 25.0% for the porcine phantom scans. In the conventional CT image group, the average DIs were respectively 35.4, 54.3, 45.4, 1.0, and 0.0% for the grid phantom and 19.4, 17.9, 3.0, 0.0, and 0.0% for the porcine phantom scans. Conclusions VNC effectively reduces the suppression of information caused by high concentrations of ICM, thereby improving the detection of MSU. Relevance statement Contrast-enhanced DECT alone may suffice for diagnosing gout without a native acquisition. Key points • Highly concentrated contrast media hinders monosodium urate crystal detection in CT imaging • Virtual noncontrast imaging redetects monosodium urate crystals in high-iodinated contrast media concentrations. • Contrast-enhanced DECT alone may suffice for diagnosing gout without a native acquisition. Graphical Abstract

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Development and validation of a quantitative method for estimation of the urate burden in patients with gouty arthritis using dual-energy computed tomography

Cited by 9 publications

References 34 publications

Uric Acid Expression in Carotid Atherosclerotic Plaque and Serum Uric Acid Are Associated With Cerebrovascular Events

Uric Acid Expression in Carotid Atherosclerotic Plaque and Serum Uric Acid Are Associated With Cerebrovascular Events

“High Score” in a Patient with Tophaceous Gout

Virtual noncontrast images reveal gouty tophi in contrast-enhanced dual-energy CT: a phantom study

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