Abstract
Objective of the study is to compare the diagnostic accuracy for detecting monosodium urate crystal deposits between dual-energy CT (DECT) and ultrasound (US). Sixty consecutive patients (49 men, mean age 62 years) with clinically suspected gout were included in this case–control study. DECT and US of feet, knees, hands and elbows were performed in all patients. Polarisation microscopy of synovial fluid or a score incorporating serum uric acid level, first MTP joint involvement, gender, previous patient-reported arthritis attack, cardiovascular diseases, joint redness and onset within 1 day was used as standard of reference. Standard of reference classified 39 patients as gout positive. Sixteen patients had gout and a concomitant rheumatic disease. Sensitivities for diagnosis of gout disease were 84.6 % (33/39) for DECT and 100 % (39/39) for US. Specificities were 85.7 % (18/21) for DECT and 76.2 % (16/21) for US. Positive and negative predictive values were 91.7 % (33/36) and 75.0 % (18/24) for DECT, 88.6 % (39/44) and 100 % (16/16) for US, respectively. Urate crystals were detected most frequently in MTP1 joints (DECT 20/78, US 58/78), any other toe joints (DECT 25/78, US 62/78) and knees (DECT 41/78, US 31/78). The volumetry of DECT computed a mean urate crystal deposit load of 2.1 cm3 (SD 9.6 cm3). A mean effective dose of ≤0.5 mSv was estimated. DECT is more specific for the diagnosis of gout than US. However, it fails to detect small urate crystal deposits. It might be particularly useful for patients with ambivalent findings, concomitant rheumatic diseases and with non-conclusive joint aspiration.
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References
Crittenden DB, Pillinger MH (2013) New therapies for gout. Annu Rev Med 64:325–337
Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T et al (2012) American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 64:1431–1446
Feig DI, Kang DH, Johnson RJ (2008) Uric acid and cardiovascular risk. N Engl J Med 359:1811–1821
Kuo CF, See LC, Luo SF, Ko YS, Lin YS, Hwang JS et al (2010) Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford) 49:141–146
Owens D, Whelan B, McCarthy G (2008) A survey of the management of gout in primary care. Ir Med J 101:147–149
McQueen FM, Doyle A, Dalbeth N (2011) Imaging in gout—what can we learn from MRI, CT, DECT and US? Arthritis Res Ther 13:246
Nicolaou S, Liang T, Murphy DT, Korzan JR, Ouellette H, Munk P (2012) Dual-energy CT: a promising new technique for assessment of the musculoskeletal system. AJR Am J Roentgenol 199(Suppl 5):S78–S86
Glazebrook KN, Guimarães LS, Murthy NS, Black DF, Bongartz T, Manek NJ et al (2011) Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology 261:516–524
Desai MA, Peterson JJ, Garner HW, Kransdorf MJ (2011) Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics 31:1365–1375
Choi HK, Burns LC, Shojania K, Koenig N, Reid G, Abufayyah M et al (2012) Dual energy CT in gout: a prospective validation study. Ann Rheum Dis 71:1466–1471
Gruber M, Bodner G, Rath E, Supp G, Weber M, Schueller-Weidekamm C (2014) Dual-energy computed tomography compared with ultrasound in the diagnosis of gout. Rheumatology (Oxford) 53:173–179
Stamm G, Nagel HD (2002) CT-expo—a novel program for dose evaluation in CT. Fortschr Röntgenstr 174:1570–1576
Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M (2010) A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med 170:1120–1126
Thiele RG, Schlesinger N (2007) Diagnosis of gout by ultrasound. Rheumatology (Oxford) 46:1116–1121
Grassi W, Meenagh G, Pascual E, Filippucci E (2006) “Crystal clear”-sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin Arthritis Rheum 36:197–202
Choi HK, Al-Arfaj AM, Eftekhari A, Munk PL, Shojania K, Reid G et al (2009) Dual energy computed tomography in tophaceous gout. Ann Rheum Dis 68:1609–1612
Dalbeth N, Schauer C, Macdonald P, Perez-Ruiz F, Schumacher HR, Hamburger S et al (2011) Methods of tophus assessment in clinical trials of chronic gout: a systematic literature review and pictorial reference guide. Ann Rheum Dis 70:597–604
McQueen FM, Reeves Q, Dalbeth N (2013) New insights into an old disease: advanced imaging in the diagnosis and management of gout. Postgrad Med J 89:87–93
Dalbeth N, Kalluru R, Aati O, Horne A, Doyle AJ, McQueen FM (2013) Tendon involvement in the feet of patients with gout: a dual-energy CT study. Ann Rheum Dis 72:1545–1548
Swan A, Amer H, Dieppe P (2002) The value of synovial fluid assays in the diagnosis of joint disease: a literature survey. Ann Rheum Dis 61:493–498
Manger B, Lell M, Wacker J, Schett G, Rech J (2012) Detection of periarticular urate deposits with dual energy CT in patients with acute gouty arthritis. Ann Rheum Dis 71:470–472
Mathieu S, Pereira B, Couderc M, Soubrier M (2013) Usefulness of ultrasonography in the diagnosis of gout: a meta-analysis. Ann Rheum Dis 72:e23
Dalbeth N, Doyle A, McQueen FM (2012) Imaging in gout: insights into the pathological features of disease. Curr Opin Rheumatol 24:132–138
Chowalloor PV, Keen HI (2013) A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia. Ann Rheum Dis 72:638–645
Wright SA, Filippucci E, McVeigh C, Grey A, McCarron M, Grassi W et al (2007) High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis 66:859–864
Filippucci E, Riveros MG, Georgescu D, Salaffi F, Grassi W (2009) Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthr Cartil 17:178–181
Peiteado D, De Miguel E, Villalba A, Ordóñez MC, Castillo C, Martín-Mola E (2012) Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clin Exp Rheumatol 30:830–837
Ottaviani S, Richette P, Allard A, Ora J, Bardin T (2012) Ultrasonography in gout: a case–control study. Clin Exp Rheumatol 30:499–504
Naredo E, Uson J, Jiménez-Palop M, Martínez A, Vicente E, Brito E et al (2013) Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis 2013 May 14 (Epub ahead of print)
Jabakumar A, Crowson CS, Udayakumar PD, Matteson EL (2012) Co-existence of gout in rheumatoid arthritis: it does happen! A population based study. Arthritis Rheum 64(Suppl):S58
Perez-Ruiz F, Herrero-Beites AM (2012) Prevalence of non-gout arthritis in patients with gout: Not as sparing as previously thought. Arthritis Rheum 64(Suppl):S63
McQueen FM, Doyle A, Reeves Q, Gao A, Tsai A, Gamble GD et al (2014) Bone erosions in patients with chronic gouty arthropathy are associated with tophi but not bone oedema or synovitis: new insights from a 3 T MRI study. Rheumatology (Oxford) 53:95–103
Acknowledgments
The authors especially thank Carina Schuecke for the CT data acquisition and Carsten Schwenke (SCOSSiS Statistical Consulting) for his assistance in the statistical evaluation.
Conflict of interest
Alexander Huppertz is a full-time paid employee of Siemens AG since June 1, 2004. His function is Associate Director of the Imaging Science Institute Charité. The Institute is a scientific cooperation between the Charité, University Hospitals of Berlin, Germany and Siemens Healthcare in form of a private–public partnership (PPP). Wolfgang A Schmidt received research grants from Esaote SpA and General Electrics. All other authors have no competing interests to declare with respect to this study.
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Huppertz, A., Hermann, KG.A., Diekhoff, T. et al. Systemic staging for urate crystal deposits with dual-energy CT and ultrasound in patients with suspected gout. Rheumatol Int 34, 763–771 (2014). https://doi.org/10.1007/s00296-014-2979-1
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DOI: https://doi.org/10.1007/s00296-014-2979-1