Osteitis: a retrospective feasibility study comparing single-source dual-energy CT to MRI in selected patients with suspected acute gout

Abstract

ObjectiveDual-energy computed tomography detects tophi in patients with chronic gout. However, other information that can be obtained from the same scan is not the focus of the current research, e.g., the detection of bone marrow edema (BME) using virtual bone marrow imaging (VBMI). The aim of this study was to evaluate if BME in patients with acute arthritis can be detected with VBMI using magnetic resonance imaging (MRI) as the standard of reference.Materials and methodsThis retrospective study included 11 patients who underwent both MRI and dual-energy computed tomography (mean interval of 40 days). BME in MRI (standard of reference) and VBMI was judged independently by two different blinded readers. φ-correlation coefficient and Cohen’s κ were performed for statistical analysis. Approval was waived by the IRB.ResultsTwo patients with a final diagnosis of RA and one with septic arthritis showed osteitis on MRI and VBMI. However, in each case, there were individual bones identified with osteitis on MRI but not VBMI. Three additional patients with the final diagnosis of RA were identified correctly as negative for BME. There was a good correlation between both modalities (φ = 0.8; κ = 0.8). Inter-rater reliability was excellent for both modalities (κ = 0.9).ConclusionsWe have shown that detecting osteitis using VBMI is feasible in patients with inflammatory arthritis. Further studies are needed on larger, more-targeted populations to better define the indications, accuracy, and added value of this technique.

Dual-energy CT: a new imaging modality for bone marrow oedema in rheumatoid arthritis

“…To our knowledge, this is the first prospective study applying DECT as a novel imaging technique for detection of BMEL in RA 8. We found that the colour-coded DECT maps differentiate normal bone marrow from BMEL and corresponded well to BME on MRI.…”

MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings

“…Likewise, standard CT is insensitive to marrow edema or inflammation, although in the future, dual-energy CT may be able to detect and potentially quantify osteitis. Preliminary pilot studies have investigated this application in patients with gout [96] and RA [97].…”

Quantitative Imaging in Inflammatory Arthritis: Between Tradition and Innovation

“…89%) for visual inspection and quantification, respectively, of bone marrow edema affecting the sacroiliac joints in patients with spondyloarthritis. 45 The detection of virtual bone marrow edema by DECT led to the diagnosis of acute arthritis 54 and active RA in the hand and wrist. 55 Finally, Fukuda et al, using iodine overlay images, demonstrated that DECT can be applied successfully for the investigation of small joints in patients with RA and PSA.…”