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Carrino JA, Ibad H, Lin Y, Ghotbi E, Klein J, Demehri S, Del Grande F, Bogner E, Boesen MP, Siewerdsen JH. CT in musculoskeletal imaging: still helpful and for what? Skeletal Radiol 2024:10.1007/s00256-024-04737-w. [PMID: 38969781 DOI: 10.1007/s00256-024-04737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024]
Abstract
Computed tomography (CT) is a common modality employed for musculoskeletal imaging. Conventional CT techniques are useful for the assessment of trauma in detection, characterization and surgical planning of complex fractures. CT arthrography can depict internal derangement lesions and impact medical decision making of orthopedic providers. In oncology, CT can have a role in the characterization of bone tumors and may elucidate soft tissue mineralization patterns. Several advances in CT technology have led to a variety of acquisition techniques with distinct clinical applications. These include four-dimensional CT, which allows examination of joints during motion; cone-beam CT, which allows examination during physiological weight-bearing conditions; dual-energy CT, which allows material decomposition useful in musculoskeletal deposition disorders (e.g., gout) and bone marrow edema detection; and photon-counting CT, which provides increased spatial resolution, decreased radiation, and material decomposition compared to standard multi-detector CT systems due to its ability to directly translate X-ray photon energies into electrical signals. Advanced acquisition techniques provide higher spatial resolution scans capable of enhanced bony microarchitecture and bone mineral density assessment. Together, these CT acquisition techniques will continue to play a substantial role in the practices of orthopedics, rheumatology, metabolic bone, oncology, and interventional radiology.
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Affiliation(s)
- John A Carrino
- Weill Cornell Medicine, New York, NY, USA.
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Hamza Ibad
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Elena Ghotbi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joshua Klein
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Shadpour Demehri
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 5165, Baltimore, MD, 21287, USA
| | - Filippo Del Grande
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
| | - Eric Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Mikael P Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Entrance 7A, 3Rd Floor, 2400, Copenhagen, NV, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeffrey H Siewerdsen
- Department of Imaging Physics, Institute for Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yokose C, Eide SE, Huber FA, Simeone FJ, Ghoshhajra BB, Shojania K, Nicolaou S, Becce F, Choi HK. Frequently Encountered Artifacts in the Application of Dual-Energy Computed Tomography to Cardiovascular Imaging for Urate Crystals in Gout: A Matched-Control Study. Arthritis Care Res (Hoboken) 2024; 76:953-963. [PMID: 38317327 PMCID: PMC11209827 DOI: 10.1002/acr.25312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/02/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE There is surging interest in using dual-energy computed tomography (DECT) to identify cardiovascular monosodium urate (MSU) deposits in patients with gout. We sought to examine the prevalence and characterization of cardiovascular DECT artifacts using non-electrocardiogram (EKG)-gated DECT pulmonary angiograms. METHODS We retrospectively reviewed non-EKG-gated DECT pulmonary angiograms performed on patients with and without gout at a single academic center. We noted the presence and locations of vascular green colorization using the default postprocessing two-material decomposition algorithm for MSU. The high- and low-energy grayscale images and advanced DECT measurements were used to determine whether they were true findings or artifacts. We classified artifacts into five categories: streak, contrast medium mixing, misregistration due to motion, foreign body, and noise. RESULTS Our study included CT scans from 48 patients with gout and 48 age- and sex-matched controls. The majority of patients were male with a mean age of 67 years. Two independent observers attributed all areas of vascular green colorization to artifacts. The most common types of artifacts were streak (56% vs 57% between patients and controls, respectively) and contrast medium mixing (51% vs 65%, respectively). Whereas some of the default DECT measurements of cardiovascular green colorization were consistent with values reported for subcutaneous tophi, advanced DECT measurements were not consistent with that of tophi. CONCLUSION Artifacts that could be misconstrued as cardiovascular MSU deposits were commonly identified in patients with and without gout on non-EKG-gated DECT pulmonary angiograms. These artifacts can inform future vascular DECT studies on patients with gout to minimize false-positive findings.
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Affiliation(s)
- Chio Yokose
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Florian A. Huber
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - F. Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian B. Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, MA
| | - Kamran Shojania
- Division of Rheumatology, Department of Medicine, Vancouver General Hospital
- Arthritis Research Canada, Vancouver BC
| | | | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Bette S, Risch F, Becker J, Popp D, Decker JA, Kaufmann D, Friedrich L, Scheurig-Münkler C, Schwarz F, Kröncke TJ. Photon-counting detector CT - first experiences in the field of musculoskeletal radiology. ROFO-FORTSCHR RONTG 2024. [PMID: 38788741 DOI: 10.1055/a-2312-6914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The introduction of photon-counting detector CT (PCD-CT) marks a remarkable leap in innovation in CT imaging. The new detector technology allows X-rays to be converted directly into an electrical signal without an intermediate step via a scintillation layer and allows the energy of individual photons to be measured. Initial data show high spatial resolution, complete elimination of electronic noise, and steady availability of spectral image data sets. In particular, the new technology shows promise with respect to the imaging of osseous structures. Recently, PCD-CT was implemented in the clinical routine. The aim of this review was to summarize recent studies and to show our first experiences with photon-counting detector technology in the field of musculoskeletal radiology.We performed a literature search using Medline and included a total of 90 articles and reviews that covered recent experimental and clinical experiences with the new technology.In this review, we focus on (1) spatial resolution and delineation of fine anatomic structures, (2) reduction of radiation dose, (3) electronic noise, (4) techniques for metal artifact reduction, and (5) possibilities of spectral imaging. This article provides insight into our first experiences with photon-counting detector technology and shows results and images from experimental and clinical studies. · This review summarizes recent experimental and clinical studies in the field of photon-counting detector CT and musculoskeletal radiology.. · The potential of photon-counting detector technology in the field of musculoskeletal radiology includes improved spatial resolution, reduction in radiation dose, metal artifact reduction, and spectral imaging.. · PCD-CT enables imaging at lower radiation doses while maintaining or even enhancing spatial resolution, crucial for reducing patient exposure, especially in repeated or prolonged imaging scenarios.. · It offers promising results in reducing metal artifacts commonly encountered in orthopedic or dental implants, enhancing the interpretability of adjacent structures in postoperative and follow-up imaging.. · With its ability to routinely acquire spectral data, PCD-CT scans allow for material classification, such as detecting urate crystals in suspected gout or visualizing bone marrow edema, potentially reducing reliance on MRI in certain cases.. Bette S, Risch F, Becker J et al. Photon-counting detector CT - first experiences in the field of musculoskeletal radiology. Fortschr Röntgenstr 2024; DOI 10.1055/a-2312-6914.
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Affiliation(s)
- Stefanie Bette
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Franka Risch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Judith Becker
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Daniel Popp
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Josua A Decker
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - David Kaufmann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Lena Friedrich
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Christian Scheurig-Münkler
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Florian Schwarz
- Institute of Conventional and Interventional Radiology, Donauisar Hospital Deggendorf, Deggendorf, Germany
| | - Thomas J Kröncke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Augsburg, Germany
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Jarraya M, Bitoun O, Wu D, Balza R, Guermazi A, Collins J, Gupta R, Nielsen GP, Guermazi E, Simeone FJ, Omoumi P, Melnic CM, Yee S. Dual energy computed tomography cannot effectively differentiate between calcium pyrophosphate and basic calcium phosphate diseases in the clinical setting. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100436. [PMID: 38384979 PMCID: PMC10879789 DOI: 10.1016/j.ocarto.2024.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Background Recent reports suggested that dual-energy CT (DECT) may help discriminate between different types of calcium phosphate crystals in vivo, which would have important implications for the characterization of crystal deposition occurring in osteoarthritis. Purpose Our aim was to test the hypothesis that DECT can effectively differentiate basic calcium phosphate (BCP) from calcium pyrophosphate (CPP) deposition diseases. Methods Discarded tissue after total knee replacement specimens in a 71 year-old patient with knee osteoarthritis and chondrocalcinosis was scanned using DECT at standard clinical parameters. Specimens were then examined on light microscopy which revealed CPP deposition in 4 specimens (medial femoral condyle, lateral tibial plateau and both menisci) without BCP deposition. Regions of interest were placed on post-processed CT images using Rho/Z maps (Syngo.via, Siemens Healthineers, VB10B) in different areas of CPP deposition, trabecular bone BCP (T-BCP) and subchondral bone plate BCP (C-BCP). Results Dual Energy Index (DEI) of CPP was 0.12 (SD = 0.02) for reader 1 and 0.09 (SD = 0.03) for reader 2, The effective atomic number (Zeff) of CPP was 10.83 (SD = 0.44) for reader 1 and 10.11 (SD = 0.66) for reader 2. Nearly all DECT parameters of CPP were higher than those of T-BCP, lower than those of C-BCP, and largely overlapping with Aggregate-BCP (aggregate of T-BCP and C-BCP). Conclusion Differentiation of different types of calcium crystals using DECT is not feasible in a clinical setting.
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Affiliation(s)
- Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivier Bitoun
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dufan Wu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rene Balza
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Guermazi
- VA Boston Healthcare, Boston University School of Medicine, Boston, MA, USA
| | - Jamie Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, USA
| | - Rajiv Gupta
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gunnlaugur Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - F. Joseph Simeone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick Omoumi
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Christopher M. Melnic
- Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seonghwan Yee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sirotti S, Terslev L, Filippucci E, Iagnocco A, Moller I, Naredo E, Vreju FA, Adinolfi A, Becce F, Hammer HB, Cazenave T, Cipolletta E, Christiansen SN, Delle Sedie A, Diaz M, Figus F, Mandl P, MacCarter D, Mortada MA, Mouterde G, Porta F, Reginato AM, Schmidt WA, Serban T, Wakefield RJ, Zufferey P, Sarzi-Puttini P, Zanetti A, Damiani A, Pineda C, Keen HI, D'Agostino MA, Filippou G. Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level. THE LANCET. RHEUMATOLOGY 2023; 5:e474-e482. [PMID: 38251579 DOI: 10.1016/s2665-9913(23)00136-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The Calcium Pyrophosphate Deposition (CPPD) subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound working group was established to validate ultrasound as an outcome measure instrument for CPPD, and in 2017 has developed and validated standardised definitions for elementary lesions for the detection of calcium pyrophosphate crystals in joints. The aim of this study was to develop and evaluate the reliability of a consensus-based ultrasound scoring system for CPPD extent, representing the next phase in the OMERACT methodology. METHODS In this study the novel scoring system for CPPD was developed through a stepwise process, following an established OMERACT ultrasound methodology. Following a previous systematic review to gather available evidence on existing scoring systems for CPPD, the novel scoring system was developed through a Delphi survey based on the expert opinion of the members of the OMERACT Ultrasound working group-CPPD subgroup. The reliability of the scoring system was then tested on a web-based and patient-based exercise. Intra-reader and inter-reader reliability of the new scoring system was assessed using weighted Light's κ coefficients. FINDINGS The four-grade semiquantitative scoring system consisted of: grade 0 (no findings consistent with CPPD), grade 1 (≤3 single spots or 1 small deposit), grade 2 (>3 single spots or >1 small deposit or ≥1 larger deposit occupying ≤50% of the structure under examination in the reference image-ie, the scanning view with the highest grade of depositions), and grade 3 (deposits that occupy more than 50% of the structure under examination in the reference image). The score should be applied to the knee (menisci and hyaline cartilage) and the triangular fibrocartilage complex of the wrist. The intra-reader and inter-reader reliabilities on static images were almost perfect (κ 0·90 [95% CI 0·79-1·00] and κ 0·84 [0·79-0·88]), and on the eight patients recruited (four [50%] female and four [50%] male) were substantial (κ 0·72 [95% CI 0·47 to 0·96] and 0·66 [0·61 to 0·71]). INTERPRETATION This OMERACT ultrasound scoring system for CPPD was reliable on both static images and patients. The scoring system might be a valuable tool for ensuring valid and comparable results in clinical trials and could help monitor the extent of crystal deposition in patients with CPPD in clinical practice. FUNDING The Italian Ministry of Health - Ricerca Corrente.
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Affiliation(s)
- Silvia Sirotti
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Annamaria Iagnocco
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Ingrid Moller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; IIS-FJD, Universidad Autónoma of Madrid, Madrid, Spain
| | - Florentin A Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Antonella Adinolfi
- Rheumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Diaz
- Rheumatology Unit, University Hospital Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Fabiana Figus
- Rheumatology Service, ASL Torino 3, Collegno Pinerolo, Turin, Italy
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Daryl MacCarter
- Department of Rheumatology, North Valley Hospital, Whitefish, MT, USA
| | - Mohamed A Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Gael Mouterde
- Rheumatology Department & IDESP, CHU Montpellier, Montpellier University, Montpellier, France
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Rheumatology Section, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Anthony M Reginato
- Division of Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Teodora Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa, Italy
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK
| | - Pascal Zufferey
- Rheumatology Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Piercarlo Sarzi-Puttini
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Anna Zanetti
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy
| | - Arianna Damiani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth, WA, Australia
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Georgios Filippou
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy.
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Garcelon C, Abascal J, Olivier C, Uk S, Si-Mohamed S, Ea HK, Douek P, Peyrin F, Chappard C. Quantification of cartilage and subchondral bone cysts on knee specimens based on a spectral photon-counting computed tomography. Sci Rep 2023; 13:11080. [PMID: 37422514 PMCID: PMC10329701 DOI: 10.1038/s41598-023-38238-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 07/05/2023] [Indexed: 07/10/2023] Open
Abstract
Spectral photon-counting computed tomography (SPCCT) is a new technique with the capability to provide mono-energetic (monoE) images with high signal to noise ratio. We demonstrate the feasibility of SPCCT to characterize at the same time cartilage and subchondral bone cysts (SBCs) without contrast agent in osteoarthritis (OA). To achieve this goal, 10 human knee specimens (6 normal and 4 with OA) were imaged with a clinical prototype SPCCT. The monoE images at 60 keV with isotropic voxels of 250 × 250 × 250 µm3 were compared with monoE synchrotron radiation CT (SR micro-CT) images at 55 keV with isotropic voxels of 45 × 45 × 45 µm3 used as benchmark for cartilage segmentation. In the two OA knees with SBCs, the volume and density of SBCs were evaluated in SPCCT images. In 25 compartments (lateral tibial (LT), medial tibial, (MT), lateral femoral (LF), medial femoral and patella), the mean bias between SPCCT and SR micro-CT analyses were 101 ± 272 mm3 for cartilage volume and 0.33 mm ± 0.18 for mean cartilage thickness. Between normal and OA knees, mean cartilage thicknesses were found statistically different (0.005 < p < 0.04) for LT, MT and LF compartments. The 2 OA knees displayed different SBCs profiles in terms of volume, density, and distribution according to size and location. SPCCT with fast acquisitions is able to characterize cartilage morphology and SBCs. SPCCT can be used potentially as a new tool in clinical studies in OA.
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Affiliation(s)
- Célestin Garcelon
- Paris Cité University, CNRS, INSERM, B3OA UMR 7052 U1273, Paris, France
| | - Juan Abascal
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Cecile Olivier
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Stéphanie Uk
- Paris Cité University, CNRS, INSERM, B3OA UMR 7052 U1273, Paris, France
| | - Salim Si-Mohamed
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Hang-Korng Ea
- Rheumatology Department, University Paris Cité, Paris, France
| | - Philippe Douek
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Francoise Peyrin
- University of Lyon, INSA-Lyon, CNRS, INSERM, CREATIS UMR 5220, U1206, Lyon, France
| | - Christine Chappard
- Paris Cité University, CNRS, INSERM, B3OA UMR 7052 U1273, Paris, France.
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Layer YC, Kravchenko D, Dell T, Kütting D. [CT technology: photon-counting detector computed tomography]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01166-z. [PMID: 37289254 DOI: 10.1007/s00117-023-01166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Photon-counting detector computed tomography (PCD-CT) is a CT technology that overcomes many limitations of conventional detectors. Direct conversion of photons hitting the detector into electrical signals combined with more sensitive and accurate photon detection simultaneously allows spectral evaluation and also potential reduction in radiation exposure to the patient. The combination of energy thresholds and elimination of detector septa allows for a reduction of electronic noise, an increase of spatial resolution, and an improvement of dose efficiency. ACHIEVEMENTS Recent research has confirmed significantly reduced image noise, reduced radiation dose, increased spatial resolution, improved iodine signal, and a reduction in artifacts. Spectral imaging potentiates these effects and also allows retrospective calculation of virtual monoenergetic images, virtual noncontrast images or iodine maps. Thus, the photon-counting technique offers the possibility of using various contrast agents, with the prospect of single-scan multiphase imaging or visualization of specific metabolic processes. Therefore, further research and complementary approval processes are necessary for clinical application. Likewise, further research is needed to develop and validate optimal settings and reconstructions for a wide variety of situations, as well as to test new application possibilities. CONCLUSIONS The only photon-counting detector CT device available on the market to date received clinical approval in 2021. It remains to be seen which other applications will become possible through improvements in hardware and software. This technology has already demonstrated an impressive superiority compared with the current standard of CT imaging, especially regarding high-resolution imaging of detailed structures and examinations with high radiation exposure.
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Affiliation(s)
- Yannik Christian Layer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Dmitrij Kravchenko
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Tatjana Dell
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Daniel Kütting
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Cademartiri F, Meloni A, Pistoia L, Degiorgi G, Clemente A, De Gori C, Positano V, Celi S, Berti S, Emdin M, Panetta D, Menichetti L, Punzo B, Cavaliere C, Bossone E, Saba L, Cau R, Grutta LL, Maffei E. Dual Source Photon-Counting Computed Tomography-Part II: Clinical Overview of Neurovascular Applications. J Clin Med 2023; 12:jcm12113626. [PMID: 37297821 DOI: 10.3390/jcm12113626] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
Photon-counting detector (PCD) is a novel computed tomography detector technology (photon-counting computed tomography-PCCT) that presents many advantages in the neurovascular field, such as increased spatial resolution, reduced radiation exposure, and optimization of the use of contrast agents and material decomposition. In this overview of the existing literature on PCCT, we describe the physical principles, the advantages and the disadvantages of conventional energy integrating detectors and PCDs, and finally, we discuss the applications of the PCD, focusing specifically on its implementation in the neurovascular field.
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Affiliation(s)
| | - Antonella Meloni
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Giulia Degiorgi
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Carmelo De Gori
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Simona Celi
- BioCardioLab, Department of Bioengineering, Fondazione Monasterio/CNR, 54100 Massa, Italy
| | - Sergio Berti
- Cardiology Unit, Ospedale del Cuore, Fondazione Monasterio/CNR, 54100 Massa, Italy
| | - Michele Emdin
- Department of Cardiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
| | - Daniele Panetta
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy
| | - Luca Menichetti
- Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy
| | - Bruna Punzo
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy
| | - Carlo Cavaliere
- Department of Radiology, IRCCS SynLab-SDN, 80131 Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, 80131 Naples, Italy
| | - Luca Saba
- Department of Radiology, University Hospital, 09042 Monserrato, Italy
| | - Riccardo Cau
- Department of Radiology, University Hospital, 09042 Monserrato, Italy
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, Department of Radiology, University Hospital "P. Giaccone", 90127 Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy
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9
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Liew JW. Intra-articular Mineralization and Association with Osteoarthritis Development and Outcomes. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2023. [DOI: 10.1007/s40674-023-00203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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10
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Hellberg I, Karjalainen VP, Finnilä MAJ, Jonsson E, Turkiewicz A, Önnerfjord P, Hughes V, Tjörnstrand J, Englund M, Saarakkala S. 3D analysis and grading of calcifications from ex vivo human meniscus. Osteoarthritis Cartilage 2023; 31:482-492. [PMID: 36356928 PMCID: PMC7614369 DOI: 10.1016/j.joca.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Meniscal calcifications are associated with the pathogenesis of knee osteoarthritis (OA). We propose a micro-computed tomography (μCT) based 3D analysis of meniscal calcifications ex vivo, including a new grading system. METHOD Human medial and lateral menisci were obtained from 10 patients having total knee replacement for medial compartment OA and 10 deceased donors without knee OA (healthy references). The samples were fixed; one subsection was imaged with μCT, and the adjacent tissue was processed for histological evaluation. Calcifications were examined from the reconstructed 3D μCT images, and a new grading system was developed. To validate the grading system, meniscal calcification volumes (CVM) were quantitatively analyzed and compared between the calcification grades. Furthermore, we estimated the relationship between histopathological degeneration and the calcification severity. RESULTS 3D μCT images depict calcifications in every sample, including diminutive calcifications that are not visible in histology. In the new grading system, starting from grade 2, each grade results in a CVM that is 20.3 times higher (95% CI 13.3-30.5) than in the previous grade. However, there was no apparent difference in CVM between grades 1 and 2. The calcification grades appear to increase with the increasing histopathological degeneration, although histopathological degeneration is also observed with small calcification grades. CONCLUSIONS 3D μCT grading of meniscal calcifications is feasible. Interestingly, it seems that there are two patterns of degeneration in the menisci of our sample set: 1) with diminutive calcifications (calcification grades 1-2), and 2) with large to widespread calcifications (calcification grades 3-5).
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Affiliation(s)
- I Hellberg
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - V-P Karjalainen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - M A J Finnilä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - E Jonsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology and Molecular Skeletal Biology, Lund, Sweden.
| | - A Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden.
| | - P Önnerfjord
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology and Molecular Skeletal Biology, Lund, Sweden.
| | - V Hughes
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden.
| | - J Tjörnstrand
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden.
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
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Moghiseh M, Searle E, Dixit D, Kim J, Dong YC, Cormode DP, Butler A, Gieseg SP. Spectral Photon-Counting CT Imaging of Gold Nanoparticle Labelled Monocytes for Detection of Atherosclerosis: A Preclinical Study. Diagnostics (Basel) 2023; 13:diagnostics13030499. [PMID: 36766602 PMCID: PMC9914700 DOI: 10.3390/diagnostics13030499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
A key process in the development of atherosclerotic plaques is the recruitment of monocytes into the artery wall. Using spectral photon-counting computed tomography we examine whether monocyte deposition within the artery wall of ApoE-/- mouse can be detected. Primary mouse monocytes were labelled by incubating them with 15 nm gold nanoparticles coated with 11-mercaptoundecanoic acid The monocyte uptake of the particle was confirmed by electron microscopy of the cells before injection into 6-week-old apolipoprotein E deficient (ApoE-/-) mouse that had been fed with the Western diet for 10 weeks. Four days following injection, the mouse was sacrificed and imaged using a MARS spectral photon counting computed tomography scanner with a spectral range of 7 to 120 KeV with five energy bins. Imaging analysis showed the presence of X-ray dense material within the mouse aortic arch which was consistent with the spectral characteristic of gold rather than calcium. The imaging is interpreted as showing the deposition of gold nanoparticles containing monocytes within the mouse aorta. The results of our study determined that spectral photon-counting computed tomography could provide quantitative information about gold nanoparticles labelled monocytes in voxels of 90 × 90 × 90 µm3. The imaging was consistent with previous micro-CT and electron microscopy of mice using the same nanoparticles. This study demonstrates that spectral photon-counting computed tomography, using a MARS small bore scanner, can detect a fundamental atherogenic process within mouse models of atherogenesis. The present study demonstrates the feasibility of spectral photon-counting computed tomography as an emerging molecular imaging modality to detect atherosclerotic disease.
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Affiliation(s)
- Mahdieh Moghiseh
- Department of Radiology, University of Otago, Christchurch 9016, New Zealand
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Correspondence: (M.M.); (S.P.G.)
| | - Emily Searle
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Free Radical Biochemistry Laboratory, School of Biological Sciences, University of Canterbury, Christchurch 8041, New Zealand
- Department of Physics and Astronomy, University of Canterbury, Christchurch 8041, New Zealand
| | - Devyani Dixit
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Free Radical Biochemistry Laboratory, School of Biological Sciences, University of Canterbury, Christchurch 8041, New Zealand
| | - Johoon Kim
- Departments of Radiology, Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yuxi C. Dong
- Departments of Radiology, Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David P. Cormode
- Departments of Radiology, Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anthony Butler
- Department of Radiology, University of Otago, Christchurch 9016, New Zealand
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Department of Physics and Astronomy, University of Canterbury, Christchurch 8041, New Zealand
- European Organization for Nuclear Research (CERN), 1211 Meyrin, Switzerland
| | - Steven P. Gieseg
- Department of Radiology, University of Otago, Christchurch 9016, New Zealand
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Free Radical Biochemistry Laboratory, School of Biological Sciences, University of Canterbury, Christchurch 8041, New Zealand
- European Organization for Nuclear Research (CERN), 1211 Meyrin, Switzerland
- Correspondence: (M.M.); (S.P.G.)
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12
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Bernabei I, So A, Busso N, Nasi S. Cartilage calcification in osteoarthritis: mechanisms and clinical relevance. Nat Rev Rheumatol 2023; 19:10-27. [PMID: 36509917 DOI: 10.1038/s41584-022-00875-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Pathological calcification of cartilage is a hallmark of osteoarthritis (OA). Calcification can be observed both at the cartilage surface and in its deeper layers. The formation of calcium-containing crystals, typically basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate (CPP) crystals, is an active, highly regulated and complex biological process that is initiated by chondrocytes and modified by genetic factors, dysregulated mitophagy or apoptosis, inflammation and the activation of specific cellular-signalling pathways. The links between OA and BCP deposition are stronger than those observed between OA and CPP deposition. Here, we review the molecular processes involved in cartilage calcification in OA and summarize the effects of calcium crystals on chondrocytes, synovial fibroblasts, macrophages and bone cells. Finally, we highlight therapeutic pathways leading to decreased joint calcification and potential new drugs that could treat not only OA but also other diseases associated with pathological calcification.
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Affiliation(s)
- Ilaria Bernabei
- Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alexander So
- Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Nathalie Busso
- Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sonia Nasi
- Service of Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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13
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Sirotti S, Becce F, Sconfienza LM, Terslev L, Naredo E, Zufferey P, Pineda C, Gutierrez M, Adinolfi A, Serban T, MacCarter D, Mouterde G, Zanetti A, Scanu A, Möller I, Novo-Rivas U, Largo R, Sarzi-Puttini P, Abhishek A, Choi HK, Dalbeth N, Pascart T, Tedeschi SK, D'Agostino MA, Iagnocco A, Keen HI, Scirè CA, Filippou G. Reliability and Diagnostic Accuracy of Radiography for the Diagnosis of Calcium Pyrophosphate Deposition: Performance of the Novel Definitions Developed by an International Multidisciplinary Working Group. Arthritis Rheumatol 2022; 75:630-638. [PMID: 36122187 DOI: 10.1002/art.42368] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/07/2022] [Accepted: 09/13/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD). METHODS Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologists twice assessed radiographic images for presence or absence of CPPD in menisci, hyaline cartilage, tendons, joint capsule, or synovial membrane, using the new definitions. In case of disagreement, a consensus decision was made and considered for the assessment of diagnostic performance. Histologic examination of postsurgical specimens under compensated polarized light microscopy was the reference standard. Prevalence-adjusted bias-adjusted kappa values were used to assess reliability, and diagnostic performance statistics were calculated. RESULTS Sixty-seven patients were enrolled for the reliability study. The interobserver reliability was substantial in most of the assessed structures when considering all 4 readers (κ range 0.59-0.90), substantial to almost perfect among radiologists (κ range 0.70-0.91), and moderate to almost perfect among rheumatologists (κ range 0.46-0.88). The intraobserver reliability was substantial to almost perfect for all the observers (κ range 0.70-1). Fifty-one patients were included in the accuracy study. Radiography demonstrated an overall specificity of 92% for CPPD, but sensitivity remained low for all sites and for the overall diagnosis (54%). CONCLUSION The new radiographic definitions of CPPD are highly specific against the gold standard of histologic diagnosis. When the described radiographic findings are present, these definitions allow for a definitive diagnosis of CPPD, rather than other calcium-containing crystal depositions; however, a negative radiographic finding does not exclude the diagnosis.
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Affiliation(s)
- Silvia Sirotti
- Rheumatology Department, Luigi Sacco University Hospital and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luca M Sconfienza
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, and IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Pascal Zufferey
- Rheumatology Department, University of Lausanne, CHUV, Lausanne, Switzerland
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Marwin Gutierrez
- Division of Rheumatology, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Antonella Adinolfi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Teodora Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa, Italy
| | - Daryl MacCarter
- Rheumatology Department, North Valley Hospital, Whitefish, Montana
| | - Gael Mouterde
- Rheumatology Department, CHU Montpellier, Montpellier University, Montpellier, France
| | - Anna Zanetti
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy
| | - Anna Scanu
- Department of Neurosciences, Physical Medicine and Rehabilitation School, University of Padova, Padova, Italy
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Ulrike Novo-Rivas
- Department of Radiology, Hospital Universitario Fundación Jiménez Diáz, Universidad Autónoma, Madrid, Spain
| | - Raquel Largo
- Joint and Bone Research Unit, Rheumatology Department, IIS-Fundación Jiménez Diáz, Universidad Autónoma, Madrid, Spain
| | - Piercarlo Sarzi-Puttini
- Rheumatology Department, Luigi Sacco University Hospital and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tristan Pascart
- Rheumatology Department, Groupe Hospitalier de l'Institut Catholique de Lille, Lille Catholic University, Lille, France
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Maria-Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth, Australia
| | - Carlo A Scirè
- Società Italiana di Reumatologia, Epidemiology Research Unit, and School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Georgios Filippou
- IRCCS Istituto Ortopedico Galeazzi, Rheumatology Department, Milan, Italy
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Gauffenic A, Bazin D, Combes C, Daudon M, Ea HK. Pathological calcifications in the human joint. CR CHIM 2022. [DOI: 10.5802/crchim.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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15
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Toprover M, Mechlin M, Fields T, Oh C, Becce F, Pillinger MH. Monosodium urate deposition in the lumbosacral spine of patients with gout compared with non-gout controls: A dual-energy CT study. Semin Arthritis Rheum 2022; 56:152064. [PMID: 35803060 DOI: 10.1016/j.semarthrit.2022.152064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gout is the most common cause of inflammatory arthritis in adults. Gout predominantly affects the peripheral joints, but an increasing number of published cases report gout affecting the spine. We used dual-energy CT (DECT) to assess the prevalence of monosodium urate (MSU) deposition in the spine of gout patients compared to controls, and to investigate whether gout or spinal MSU deposition is associated with low back pain. METHODS 25 controls and 50 gout subjects (non-tophaceous and tophaceous) were enrolled. Demographics, gout history, Aberdeen back pain score, serum urate (sU), ESR and CRP were ascertained. Subjects underwent DECT of the lumbosacral spine, which was analyzed using manufacturer's default post-processing algorithm for MSU deposition as well as a maximally-specific algorithm to exclude potential artifact. FINDINGS 72 subjects were analyzed (25 control, 47 gout). Gout subjects had greater BMI, serum creatinine, sU, CRP, and ESR versus controls. Using the default algorithm, MSU-coded volumes in the lumbosacral spines were significantly higher among the gout subjects vs controls (p = 0.018). 34% of gout subjects vs 4% of controls had spinal MSU-coded deposition (p = 0.0036). Applying the maximally-specific DECT post-processing algorithm, 18% of gout patients vs 0% of controls continued to demonstrate spinal MSU-coded deposition (p = 0.04). Non-tophaceous and tophaceous subjects did not differ in spinal MSU-coded deposition or sU. Gout patients had more back pain than controls. INTERPRETATION A significant subpopulation of gout patients have spinal MSU-coded lesions. Default and maximally-specific MSU post-processing algorithms yielded different absolute MSU-coded volumes, but similar patterns of results. Gout patients had more back pain than controls. Spinal MSU deposition in gout patients may have implications for clinical picture and treatment.
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Affiliation(s)
- Michael Toprover
- From the Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, USA; Rheumatology Section, NY Harbor Health Care System New York Campus, United States Department of Veterans Affairs, USA.
| | - Michael Mechlin
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, USA
| | - Theodore Fields
- Division of Rheumatology, The Hospital for Special Surgery, USA
| | - Cheongeun Oh
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, USA
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Michael H Pillinger
- From the Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, USA; Rheumatology Section, NY Harbor Health Care System New York Campus, United States Department of Veterans Affairs, USA
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Pascart T, Budzik JF. Dual-energy computed tomography in crystalline arthritis: knowns and unknowns. Curr Opin Rheumatol 2022; 34:103-110. [PMID: 35034071 DOI: 10.1097/bor.0000000000000863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To give an overview of what can reasonably be considered as known about dual-energy computed tomography (DECT) in crystal-related arthropathies, and what still needs to be explored. RECENT FINDINGS Recent studies suggest an overall superiority of DECT over ultrasound in gout in terms of sensitivity (89 vs. 84%) and specificity (91 vs. 84%), except in early disease. Additional studies are needed to optimize DECT postprocessing settings in order to improve the specificity of the technique and eliminate all artifacts. Evidence has been controversial concerning DECT's ability to detect monosodium urate (MSU) crystal deposits on vessel walls, or whether or not MSU-coded plaques are artifacts. DECT can be used to monitor MSU crystal depletion during urate-lowering treatment; MSU crystal volume is associated with cardiovascular risk and disease activity. There are some reports on calcium-containing crystal deposition diseases (calcium pyrophosphate and basic calcium phosphate) demonstrating that DECT can characterize and discriminate between the different types of crystals. SUMMARY Our knowledge about the use of DECT in crystal-related arthropathies continues to expand. Some unknowns have been clarified but there's still lots to learn, particularly concerning gout management and the potential use of DECT in calcium-containing crystal-related arthropathies.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals
- MabLab UR4490, University Lille, ULCO
| | - Jean-François Budzik
- MabLab UR4490, University Lille, ULCO
- Department of Diagnostic and Interventional Imaging, Lille Catholic Hospitals, University of Lille, Lille, France
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Chappard C, Abascal J, Olivier C, Si-Mohamed S, Boussel L, Piala JB, Douek P, Peyrin F. Virtual monoenergetic images from photon-counting spectral computed tomography to assess knee osteoarthritis. Eur Radiol Exp 2022; 6:10. [PMID: 35190914 PMCID: PMC8861235 DOI: 10.1186/s41747-021-00261-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/30/2021] [Indexed: 12/28/2022] Open
Abstract
Background Dual-energy computed tomography has shown a great interest for musculoskeletal pathologies. Photon-counting spectral computed tomography (PCSCT) can acquire data in multiple energy bins with the potential to increase contrast, especially for soft tissues. Our objectives were to assess the value of PCSST to characterise cartilage and to extract quantitative measures of subchondral bone integrity. Methods Seven excised human knees (3 males and 4 females; 4 normal and 3 with osteoarthritis; age 80.6 ± 14 years, mean ± standard deviation) were scanned using a clinical PCSCT prototype scanner. Tomographic image reconstruction was performed after Compton/photoelectric decomposition. Virtual monoenergetic images were generated from 40 keV to 110 keV every 10 keV (cubic voxel size 250 × 250 × 250 μm3). After selecting an optimal virtual monoenergetic image, we analysed the grey level histograms of different tissues and extracted quantitative measurements on bone cysts. Results The optimal monoenergetic images were obtained for 60 keV and 70 keV. Visual inspection revealed that these images provide sufficient spatial resolution and soft-tissue contrast to characterise surfaces, disruption, calcification of cartilage, bone osteophytes, and bone cysts. Analysis of attenuation versus energy revealed different energy fingerprint according to tissues. The volumes and numbers of bone cyst were quantified. Conclusions Virtual monoenergetic images may provide direct visualisation of both cartilage and bone details. Thus, unenhanced PCSCT appears to be a new modality for characterising the knee joint with the potential to increase the diagnostic capability of computed tomography for joint diseases and osteoarthritis.
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Liu X, Zhang X, Mo S, Liang D, Li B, Zhu J. Factors Associated with Bone Erosion in Patients with Gout: A Dual-Energy Gemstone Spectral Imaging Computed Tomography Study. Mod Rheumatol 2021; 32:1170-1174. [PMID: 34918119 DOI: 10.1093/mr/roab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to assess the factors influencing bone erosion in patients with gout using dual-energy gemstone spectral imaging CT. METHODS We compared the clinical data, laboratory indices, and tissue urate levels at the monosodium urate (MSU)-bone interface measured by dual-energy gemstone spectral imaging computed tomography of 87 gout patients with (n=41) and without (n=46) bone erosion. Logistic regression analysis was used to investigate the risk factors associated with bone erosion. RESULTS In total, 47.1% of patients with gout had bone erosion. The disease duration, serum uric acid, tissue urate levels, and the presence of tophi were significantly higher (p<0.05) in gout patients with bone erosion than in those without bone erosion. Longer disease duration (OR=1.11, 95% CI: 1.00-1.24, p<0.05) and increased tissue urate levels (OR=1.01, 95% CI: 1.00-1.02, p<0.05) were independently associated with bone erosion. Tissue urate levels at the MSU-bone interface were correlated with the presence of tophi (r=0.62, p<0.001), bone erosion (r=0.51, p<0.001), renal calculus (r=0.24, p=0.03), and serum uric acid levels (r=0.23, p=0.03). CONCLUSION This study found that longer disease duration and elevated tissue urate concentrations at the MSU-bone interface were associated with bone erosion in patients with gout.
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Affiliation(s)
- Xiaofei Liu
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Xiaohuan Zhang
- Department of Radiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Shiyan Mo
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Dongfeng Liang
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Department of Rheumatology and Immunology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Baige Li
- Department of Radiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jian Zhu
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Department of Rheumatology and Immunology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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19
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Abstract
This review highlights outcomes for patients with calcium pyrophosphate deposition (CPPD) reported in prior studies and underscores challenges to assessing outcomes of this condition. Prior clinical studies of interventions for CPPD focused on joint damage and calcification on imaging tests, joint pain, swelling, and inflammatory biomarkers. Qualitative interviews with patients with CPPD and healthcare providers additionally identified flares, overall function, and use of analgesic medications as important outcomes. Imaging evidence of joint damage and calcification is likely to be outcomes in future clinical studies of CPPD, though reliability and sensitivity to change in CPPD require further testing for several imaging modalities. Challenges to outcome measurement in CPPD include questions of attribution of signs and symptoms to CPPD versus co-existing forms of arthritis, lack of therapies to prevent or dissolve calcium pyrophosphate crystal deposition, absence of validated patient- or physician-reported CPPD outcome measures, and scarcity of large cohorts in which to study outcomes of different clinical presentations of CPPD.
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Affiliation(s)
- Ken Cai
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Rheumatology, Westmead Hospital, Westmead, Australia
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
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20
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D'Angelo T, Albrecht MH, Caudo D, Mazziotti S, Vogl TJ, Wichmann JL, Martin S, Yel I, Ascenti G, Koch V, Cicero G, Blandino A, Booz C. Virtual non-calcium dual-energy CT: clinical applications. Eur Radiol Exp 2021; 5:38. [PMID: 34476640 PMCID: PMC8413416 DOI: 10.1186/s41747-021-00228-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Dual-energy CT (DECT) has emerged into clinical routine as an imaging technique with unique postprocessing utilities that improve the evaluation of different body areas. The virtual non-calcium (VNCa) reconstruction algorithm has shown beneficial effects on the depiction of bone marrow pathologies such as bone marrow edema. Its main advantage is the ability to substantially increase the image contrast of structures that are usually covered with calcium mineral, such as calcified vessels or bone marrow, and to depict a large number of traumatic, inflammatory, infiltrative, and degenerative disorders affecting either the spine or the appendicular skeleton. Therefore, VNCa imaging represents another step forward for DECT to image conditions and disorders that usually require the use of more expensive and time-consuming techniques such as magnetic resonance imaging, positron emission tomography/CT, or bone scintigraphy. The aim of this review article is to explain the technical background of VNCa imaging, showcase its applicability in the different body regions, and provide an updated outlook on the clinical impact of this technique, which goes beyond the sole improvement in image quality.
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Affiliation(s)
- Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Moritz H Albrecht
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Danilo Caudo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Julian L Wichmann
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Simon Martin
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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21
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Døssing A, Müller FC, Becce F, Stamp L, Bliddal H, Boesen M. Dual-Energy Computed Tomography for Detection and Characterization of Monosodium Urate, Calcium Pyrophosphate, and Hydroxyapatite: A Phantom Study on Diagnostic Performance. Invest Radiol 2021; 56:417-424. [PMID: 33559986 DOI: 10.1097/rli.0000000000000756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine the diagnostic performance of dual-energy computed tomography (DECT) to detect and distinguish crystal deposits in a phantom. The primary objective was to determine the cutoff DECT ratio and the cross-sectional area (CSA) of a crystal deposit necessary to differentiate monosodium urate (MSU), calcium pyrophosphate (CPP), and calcium hydroxyapatite (HA) using DECT. Our secondary objective was to determine the concentration for limit of detection for MSU, CPP, and HA crystal deposits. Exploratory objectives included the comparison between 2 generations of DECT scanners from the same manufacturer as well as different scanner settings. MATERIALS AND METHODS We used a cylindrical soft tissue phantom with synthetic MSU, CPP, and HA crystals suspended in resin. Crystal suspension concentration increased with similar attenuation between MSU, CPP, and HA in conventional CT. The phantom was scanned on 2 dual-source DECT scanners, at 2 dose levels and all available tube voltage combinations. Both scanners had a tin (Sn) filter at the high-energy spectra. Dual-energy CT ratios were calculated for a given tube voltage combination by dividing linear regression lines of CT numbers against concentration. Dual-energy CT ratios were compared using an analysis of covariance. Receiver operating characteristic curves and corresponding areas under the curve (AUCs) were calculated for individual crystal suspension comparisons (HA vs CPP, MSU vs CPP, and MSU vs HA). RESULTS At standard clinical scan settings with 8 mGy and 80/Sn150 kV, the DECT ratios were as follows: CPP, 2.02 (95% confidence interval [CI], 1.98-2.07); HA, 2.00 (95% CI, 1.96-2.05); and MSU, 1.09 (95% CI, 1.06-1.11). Ratios varied numerically depending on the scanner and tube voltage combination. Monosodium urate crystal DECT ratios were significantly different from HA and CPP (P < 0.001), whereas DECT ratios for HA and CPP crystals did not differ significantly (P = 0.99). The differentiation of MSU crystals from both calcium crystals (HA and CPP) was excellent with an AUC of 1.00 (95% CI, 1.00-1.00) and an optimal cutoff DECT ratio of 1.43:1.40 depending on the scanner. In addition, differentiation of MSU and calcium-containing crystals (HA and CPP) required a CSA of minimum 4 pixels of crystal at standard clinical scan conditions. In contrast, differentiation between CPP and HA crystals was moderate with AUCs ranging from 0.66 (95% CI, 0.52-0.80) to 0.80 (95% CI, 0.69-0.91) and an optimal cutoff DECT ratio of 2.02:2.06 depending on the scanner. Furthermore, differentiation between CPP and HA crystals required a CSA of minimum 87 pixels of crystal at standard clinical scan conditions, corresponding to a region of interest of 3.7 mm diameter. When scanning at highest possible spectral separation and maximum dose of 50 mGy, the limit of detection for crystals within a region of interest of 50 pixels was 14 mg/cm3 for MSU and 2 mg/cm3 for both CPP and HA. CONCLUSIONS This phantom study shows that DECT can be used to detect MSU, CPP, and HA crystal deposits. Differentiation of CPP and HA was not possible in crystals deposits less than 3.7 mm in diameter, but MSU could accurately be differentiated from CPP and HA crystal deposits at standard clinical scan conditions.
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Affiliation(s)
- Anna Døssing
- From the The Parker Institute, Bispebjerg and Frederiksberg Hospital
| | - Felix Christoph Müller
- Department of Radiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Henning Bliddal
- From the The Parker Institute, Bispebjerg and Frederiksberg Hospital
| | - Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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22
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Ballabriga R, Alozy J, Bandi FN, Campbell M, Egidos N, Fernandez-Tenllado JM, Heijne EHM, Kremastiotis I, Llopart X, Madsen BJ, Pennicard D, Sriskaran V, Tlustos L. Photon Counting Detectors for X-Ray Imaging With Emphasis on CT. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2021. [DOI: 10.1109/trpms.2020.3002949] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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23
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Marfo E, Anderson NG, Butler APH, Schleich N, Carbonez P, Damet J, Lowe C, Healy J, Chernoglazov AI, Moghiseh M, Raja AY. Assessment of Material Identification Errors, Image Quality, and Radiation Doses Using Small Animal Spectral Photon-Counting CT. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2021. [DOI: 10.1109/trpms.2020.3003260] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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24
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Hsieh SS, Leng S, Rajendran K, Tao S, McCollough CH. Photon Counting CT: Clinical Applications and Future Developments. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2021; 5:441-452. [PMID: 34485784 PMCID: PMC8409241 DOI: 10.1109/trpms.2020.3020212] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The use of a photon counting detector in CT (PCD CT) is currently the subject of intense investigation and development. In this review article, we will describe potential clinical applications of this technology with a particular focus on the experience of our own institution with a prototype PCD CT scanner. PCDs have three primary advantages over conventional, energy integrating detectors (EIDs): they provide spectral information without need for a dedicated dual energy protocol; they are immune to electronic noise; and they can be made very high resolution without significant compromises to quantum efficiency. These advantages translate into several clinical applications. Metal artifacts, beam hardening artifacts, and noise streaks from photon starvation can be better mitigated using PCD CT. Certain incidental findings can be better characterized using the spectral information from PCD CT. High-contrast, high-resolution structures such as the temporal bone can be better visualized using PCD CT and at greatly reduced dose. We also discuss new possibilities on the horizon, including new contrast agents, and how anticipated improvements in PCD CT will translate to performance in these applications.
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Affiliation(s)
- Scott S Hsieh
- Department of Radiology at the Mayo Clinic, Rochester MN 55905 USA
| | - Shuai Leng
- Department of Radiology at the Mayo Clinic, Rochester MN 55905 USA
| | | | - Shengzhen Tao
- Department of Radiology at the Mayo Clinic, Rochester MN 55905 USA
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25
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Abdellatif W, Ding J, Khorshed D, Shojania K, Nicolaou S. Unravelling the mysteries of gout by multimodality imaging. Semin Arthritis Rheum 2021; 50:S17-S23. [PMID: 32620197 DOI: 10.1016/j.semarthrit.2020.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gout is a common inflammatory arthritis that manifests as an aggregate of variably symptomatic monosodium urate crystals (MSU) in the joints and surrounding tissues in addition to multisystem involvement such as genitourinary and cardiovascular systems. In recent decades, there has been a documented increase in the prevalence and incidence of gout. Risk factors for gout include obesity, dietary influences, hypertension, renal impairment, and diuretic use. A prompt diagnosis followed by uric acid lowering treatment prior to the onset of bone destruction is the goal in any suspected case of gout. Advanced imaging modalities, such as dual energy computed tomography (DECT) and ultrasonography (US), employed for the diagnosis of gout are each accompanied by advantages and disadvantages. Conventional radiography (CR), although useful in visualizing joint erosions and mineralization, is limited in its ability to diagnose gout flare. Although synovial fluid aspiration remains the gold standard for MSU crystal visualization, less-invasive imaging modalities are preferred to avoid potential complications. DECT and US in particular are useful in the diagnosis of gout. In this review, we will discuss the current state and role of imaging in the detection of gout.
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Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, Department of Emergency and Trauma Radiology, University of British Columbia/ Vancouver General Hospital, 899W 12th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Jeffrey Ding
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Kam Shojania
- Department of Rheumatology, University of British Columbia, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Department of Radiology, Department of Emergency and Trauma Radiology, University of British Columbia/ Vancouver General Hospital, 899W 12th Ave, Vancouver, BC V5Z 1M9, Canada.
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26
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Pascart T, Carpentier P, Choi HK, Norberciak L, Ducoulombier V, Luraschi H, Houvenagel E, Legrand J, Verclytte S, Becce F, Budzik JF. Identification and characterization of peripheral vascular color-coded DECT lesions in gout and non-gout patients: The VASCURATE study. Semin Arthritis Rheum 2021; 51:895-902. [PMID: 34198148 DOI: 10.1016/j.semarthrit.2021.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/17/2021] [Accepted: 06/15/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To characterize peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) and assess their association with the overall soft-tissue MSU crystal burden. METHODS Patients with suspected crystal arthropathies were prospectively included in the CRYSTALILLE inception cohort to undergo baseline knees and ankles/feet DECT scans; treatment-naive gout patients initiating treat-to-target urate-lowering therapy (ULT) underwent repeated DECT scans with concomitant serum urate level measurements at 6 and 12 months. We determined the prevalence of DECT-based vascular MSU-coded plaques in knee arteries, and assessed their association with the overall DECT volumes of soft-tissue MSU crystal deposition and coexistence of arterial calcifications. DECT attenuation parameters of vascular MSU-coded plaques were compared with dense calcified plaques, control vessels, control soft tissues, and tophi. RESULTS We investigated 126 gout patients and 26 controls; 17 ULT-naive gout patients were included in the follow-up study. The prevalence of DECT-based vascular MSU-coded plaques was comparable in gout patients (24.6%) and controls (23.1%; p=0.87). Vascular MSU-coded plaques were strongly associated with coexisting arterial calcifications (p<0.001), but not with soft-tissue MSU deposition. Characterization of vascular MSU-coded plaques revealed specific differences in DECT parameters compared with control vessels, control soft tissues, and tophi. During follow-up, vascular MSU-coded plaques remained stable despite effective ULT (p=0.64), which decreased both serum urate levels and soft-tissue MSU volumes (p<0.001). CONCLUSION Our findings suggest that DECT-based MSU-coded plaques in peripheral arteries are strongly associated with calcifications and may not reflect genuine MSU crystal deposition. Such findings should therefore not be a primary target when managing gout patients.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France.
| | - Paul Carpentier
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, USA
| | - Laurène Norberciak
- Department of Research, Biostatistics, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Hélène Luraschi
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Julie Legrand
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Sébastien Verclytte
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
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27
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The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis. Osteoarthritis Cartilage 2021; 29:619-632. [PMID: 33577959 DOI: 10.1016/j.joca.2021.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/06/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine and compare the accuracy of conventional radiography (CR) and musculoskeletal ultrasonography (US) in the diagnosis of calcium pyrophosphate (CPP) crystals deposition disease (CPPD). DESIGN A systematic search of electronic databases (PubMed, Embase, and Cochrane), conference abstracts and reference lists was undertaken. Studies which evaluated the accuracy of CR and/or US in the diagnosis of CPPD, using synovial fluid analysis (SFA), histology or classification criteria as reference tests were included. Subgroup analyses by anatomic site and by reference test were performed. RESULTS Twenty-six studies were included. Using SFA/histology as reference test, CR and US showed an excellent (CR AUC = 0.889, 95%CI = 0.811-0.967) and an outstanding (US AUC = 0.954, 95%CI = 0.907-1.0) diagnostic accuracy (p < 0.01), respectively. Furthermore, US showed a higher sensitivity (0.85, 95%CI = 0.79-0.90 vs 0.47, 95%CI = 0.40-0.55) and only a little lower specificity (0.87, 95%CI = 0.83-0.91 vs 0.95, 95%CI = 0.92-0.97) than CR. A considerable heterogeneity between the studies was found, with adopted reference test being the main source of heterogeneity. In fact, subgroup analysis showed a significant change in the diagnostic accuracy of CR, but not of US, using Ryan and McCarty criteria or SFA/histology as reference test (CR: AUC = 0.956, 95%CI = 0.925-1.0 vs AUC = 0.889, 95%CI = 0.828-0.950, respectively, p < 0.01) (US: AUC = 0.922, 95%CI = 0.842-1.0 vs AUC = 0.957, 95%CI = 0.865-1.0, respectively, p = 0.08) CONCLUSIONS: Although US is more sensitive and a little less specific than CR for identifying CPP crystals, both these two techniques showed a great diagnostic accuracy and should be regarded as complementary to each other in the diagnostic work-up of patients with CPPD.
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28
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Huber FA, Becce F, Gkoumas S, Thüring T, Steinmetz S, Letovanec I, Guggenberger R. Differentiation of Crystals Associated With Arthropathies by Spectral Photon-Counting Radiography: A Proof-of-Concept Study. Invest Radiol 2021; 56:147-152. [PMID: 32852444 DOI: 10.1097/rli.0000000000000717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aims of this study were to test whether spectral photon-counting radiography (SPCR) is able to identify and distinguish different crystals associated with arthropathies in vitro and to validate findings in a gouty human third toe ex vivo. MATERIALS AND METHODS Industry-standard calibration rods of calcium pyrophosphate, calcium hydroxyapatite (HA), and monosodium urate (MSU) were scanned with SPCR in an experimental setup. Each material was available at 3 different concentrations, and a dedicated photon-counting detector was used for SPCR, whereas validation scans were obtained on a clinical dual-energy computed tomography (DECT) scanner. Regions of interest were placed on SPCR images and consecutive DECT images to measure x-ray attenuation characteristics, including effective atomic numbers (Zeff). Statistical tests were performed for differentiation of Zeff between concentrations, materials, and imaging modalities. In addition, a third toe from a patient with chronic gouty arthritis was scanned with SPCR and DECT for differentiation of MSU from HA. RESULTS In both SPCR and DECT, significant differences in attenuation and Zeff values were found for different concentrations among (P < 0.001) and between different materials (P < 0.001). Overall, quantitative measurements of Zeff did not differ significantly between SPCR- and DECT-derived measurements (P = 0.054-0.412). In the human cadaver toe, gouty bone erosions were visible on standard grayscale radiographic images; however, spectral image decomposition revealed the nature and extent of MSU deposits and was able to separate it from bone HA by Zeff. CONCLUSIONS Identification and differentiation of different crystals related to arthropathies are possible with SPCR at comparable diagnostic accuracy to DECT. Further research is needed to assess diagnostic accuracy and clinical usability in vivo.
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Affiliation(s)
- Florian Alexander Huber
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and Faculty of Medicine, University of Zurich, Zurich
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne
| | | | | | | | - Igor Letovanec
- University Institute of Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Roman Guggenberger
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and Faculty of Medicine, University of Zurich, Zurich
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29
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Wehrse E, Klein L, Rotkopf LT, Wagner WL, Uhrig M, Heußel CP, Ziener CH, Delorme S, Heinze S, Kachelrieß M, Schlemmer HP, Sawall S. Photon-counting detectors in computed tomography: from quantum physics to clinical practice. Radiologe 2021; 61:1-10. [PMID: 33598788 DOI: 10.1007/s00117-021-00812-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
Over the last decade, a fundamentally new type of computed tomography (CT) detectors has proved its superior capabilities in both physical and preclinical evaluations and is now approaching the stage of clinical practice. These detectors are able to discriminate single photons and quantify their energy and are hence called photon-counting detectors. Among the promising benefits of this technology are improved radiation dose efficiency, increased contrast-to-noise ratio, reduced metal artifacts, improved spatial resolution, simultaneous multi-energy acquisitions, and the prospect of multi-phase imaging within a single acquisition using multiple contrast agents. Taking the conventional energy-integrating detectors as a reference, the authors demonstrate the technical principles of this new technology and provide phantom and patient images acquired by a whole-body photon-counting CT. These images serve as a basis for discussing the potential future of clinical CT.
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Affiliation(s)
- E Wehrse
- Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
- Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
| | - L Klein
- Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center, Heidelberg, Germany
| | - L T Rotkopf
- Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - W L Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - M Uhrig
- Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - C P Heußel
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - C H Ziener
- Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - S Delorme
- Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - S Heinze
- Institute of Forensic and Traffic Medicine, University Hospital Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany
| | - M Kachelrieß
- Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
- Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center, Heidelberg, Germany
| | - H-P Schlemmer
- Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - S Sawall
- Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
- Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center, Heidelberg, Germany
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30
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Bernabei I, Sayous Y, Raja AY, Amma MR, Viry A, Steinmetz S, Falgayrac G, van Heeswijk RB, Omoumi P, Pascart T, Stamp LK, Nasi S, Hügle T, Busso N, So AK, Becce F. Multi-energy photon-counting computed tomography versus other clinical imaging techniques for the identification of articular calcium crystal deposition. Rheumatology (Oxford) 2021; 60:2483-2485. [DOI: 10.1093/rheumatology/keab125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/23/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Ilaria Bernabei
- Department of Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Yann Sayous
- Department of Physics and Astronomy, University of Canterbury
| | - Aamir Y Raja
- Department of Radiology, University of Otago, Christchurch, New Zealand
- Department of Physics, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Maya R Amma
- Department of Radiology, University of Otago, Christchurch, New Zealand
| | | | - Sylvain Steinmetz
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Guillaume Falgayrac
- Marrow Adiposity and Bone Laboratory (MABLab), UR 4490, University of Lille, Lille, France
| | - Ruud B van Heeswijk
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tristan Pascart
- Marrow Adiposity and Bone Laboratory (MABLab), UR 4490, University of Lille, Lille, France
- Department of Rheumatology, Lille Catholic University Hospitals, University of Lille, Lille, France
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sonia Nasi
- Department of Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nathalie Busso
- Department of Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexander K So
- Department of Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Multi-energy spectral photon-counting computed tomography (MARS) for detection of arthroplasty implant failure. Sci Rep 2021; 11:1554. [PMID: 33452309 PMCID: PMC7810731 DOI: 10.1038/s41598-020-80463-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/21/2020] [Indexed: 01/22/2023] Open
Abstract
To determine whether state-of-the-art multi-energy spectral photon-counting computed tomography (MARS) can detect knee arthroplasty implant failure not detected by standard pre-operative imaging techniques. A total knee arthroplasty (TKA) removed from a patient was reviewed. The extracted prosthesis [NexGen Legacy Posterior Stabilized (LPS) TKA] was analyzed as were pre-operative imaging examination and compared with a MARS-CT examination obtained of the extracted TKA prosthesis. Radiographs, fluoroscopy, ultrasound and MRI preoperatively did not reveal the cause of the implant failure. MARS CT images of the extracted prosthesis clearly showed the presence of posteromedial polyethylene and tibial tray wear which is compatible with the clinical appearance of the extracted TKA. MARS can identify polyethylene insert and metallic tibial tray wear as a cause of TKA failure, that could not be identified with on standard pre-operative imaging. Although clinical MARS CT system is still under development, this case does illustrate its potential clinical usefulness. This is the first study to document how MARS CT imaging can detect orthopedic implant failure not detected by standard current imaging techniques. This system has a potential clinical application in orthopedic patients.
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Collinot JA, Pascart T, Budzik JF, Hügle T, Hussenot M, Becce F. Non-invasive characterization of intra-articular mineralization using dual-energy computed tomography. Rheumatology (Oxford) 2020; 59:3997-3998. [PMID: 32533188 DOI: 10.1093/rheumatology/keaa231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jean-Aibert Collinot
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France.,EA 4490, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, Lille, France
| | - Jean-François Budzik
- EA 4490, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, Lille, France.,Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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A critical review of the available evidence on the diagnosis and clinical features of CPPD: do we really need imaging? Clin Rheumatol 2020; 40:2581-2592. [PMID: 33231775 DOI: 10.1007/s10067-020-05516-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
Imaging has been playing an important role in the pathogenetic and clinical characterisation of many rheumatic diseases, especially in the most recent years with the advent of many new, highly technological and promising techniques. Calcium pyrophosphate deposition disease (CPPD) benefited also from these new techniques, most of which can readily identify calcium crystals. Nowadays, imaging is used mainly to identify crystals in joints but given the complexity of CPPD, imaging should be used with an "holistic" approach in order to gain insights in the pathogenesis, spectrum of clinical manifestations and natural history of the disease. Furthermore, overlap or association of CPPD with other prevalent diseases of the elderly makes the differential diagnosis challenging. In this review, we provide a critical review of the current knowledge on the use of imaging both for the identification of crystals and for its application in clinical practice as an aid for determining the impact of the disease on patients.Key Points• CPPD is a complex disease with a wide spectrum of clinical manifestations and understanding of pathogenetic mechanisms and clinical phenotypes is essential for correct characterisation• Imaging has made important advances regarding identification of CPPD in recent years, and new, more sophisticated techniques are under investigation• Imaging has the potential to improve our knowledge on pathogenesis and clinical phenotypes of CPPD• Imaging techniques have to be tested thoroughly for reliability, discrimination and sensitivity to change before they can be implemented in clinical trials.
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Budzik JF, Marzin C, Legrand J, Norberciak L, Becce F, Pascart T. Can Dual-Energy Computed Tomography Be Used to Identify Early Calcium Crystal Deposition in the Knees of Patients With Calcium Pyrophosphate Deposition? Arthritis Rheumatol 2020; 73:687-692. [PMID: 33131218 DOI: 10.1002/art.41569] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the ability of dual-energy computed tomography (DECT) in identifying early calcium crystal deposition in menisci and articular cartilage of the knee, depending on the presence/absence of chondrocalcinosis seen on conventional CT. METHODS One hundred thirty-two knee DECT scans from patients with suspected crystal-associated arthropathy were reviewed and assigned to a calcium pyrophosphate deposition (CPPD) group (n = 50) or a control group (n = 82). Five DECT attenuation parameters were measured in preset regions of interest (ROIs) in menisci and articular cartilage and compared between groups using linear mixed models with adjustment for confounders. Subgroup analysis, excluding ROIs with chondrocalcinosis seen on conventional CT, was performed. RESULTS In both menisci and articular cartilage, and for all 5 DECT attenuation parameters, calcified ROIs in CPPD patients showed significantly higher values than ROIs in controls (P ≤ 0.036). Conversely, noncalcified ROIs in CPPD patients were comparable with those in controls (P ≥ 0.09). While specific DECT parameters yielded good accuracy (area under the curve [AUC] 0.87-0.88) in differentiating calcified ROIs in CPPD patients from ROIs in controls, DECT failed to distinguish between noncalcified ROIs in CPPD patients and controls (AUC 0.58-0.59). CONCLUSION While DECT has the potential to characterize knee intraarticular mineralization, this technique cannot yet accurately identify early calcium crystal deposition that is not visible as chondrocalcinosis on conventional CT.
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Affiliation(s)
- Jean-François Budzik
- Lille Catholic University Hospital Group, MABLab ULR 4490, University of Lille, Lille, France
| | - Claire Marzin
- Lille Catholic University Hospital Group, University of Lille, Lille, France
| | - Julie Legrand
- Lille Catholic University Hospital Group, University of Lille, Lille, France
| | - Laurène Norberciak
- Lille Catholic University Hospital Group, University of Lille, Lille, France
| | - Fabio Becce
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tristan Pascart
- Lille Catholic University Hospital Group, MABLab ULR 4490, University of Lille, Lille, France
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Filippucci E, Reginato AM, Thiele RG. Imaging of crystalline arthropathy in 2020. Best Pract Res Clin Rheumatol 2020; 34:101595. [PMID: 33012644 DOI: 10.1016/j.berh.2020.101595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Crystal-related arthropathies are the result of crystal deposition in joint and periarticular soft tissues. Identification of urate crystals is mandatory to distinguish gout from other crystalline arthropathies, including calcium pyrophosphate dihydrate and basic calcium phosphate crystal deposition diseases. ACR/EULAR classification criteria for gout included dual-energy computed tomography and ultrasound with equal impact to the final score. Different diagnostic strengths of these imaging modalities depend on disease duration and scanned anatomic site. While ultrasound has been indicated as the first-choice imaging technique, especially in the early stages of the disease, dual-energy computed tomography has shown to be highly specific, allowing the detection of crystal deposits in anatomic sites not accessible by ultrasound, such as the spine. At the spinal level, MRI findings are usually nonspecific. Finally, there is preliminary evidence that at the knee, dual-energy computed tomography may discriminate calcium pyrophosphate dihydrate from basic calcium phosphate crystal deposits.
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Affiliation(s)
- Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy.
| | - Anthony M Reginato
- Division of Rheumatology, Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Ralf G Thiele
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester, Rochester, NY, USA.
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Christiansen SN, Müller FC, Østergaard M, Slot O, Møller JM, Børgesen HF, Gosvig KK, Terslev L. Dual-energy CT in gout patients: Do all colour-coded lesions actually represent monosodium urate crystals? Arthritis Res Ther 2020; 22:212. [PMID: 32917279 PMCID: PMC7488422 DOI: 10.1186/s13075-020-02283-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/31/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Dual-energy CT (DECT) can acknowledge differences in tissue compositions and can colour-code tissues with specific features including monosodium urate (MSU) crystals. However, when evaluating gout patients, DECT frequently colour-codes material not truly representing MSU crystals and this might lead to misinterpretations. The characteristics of and variations in properties of colour-coded DECT lesions in gout patients have not yet been systematically investigated. The objective of this study was to evaluate the properties and locations of colour-coded DECT lesions in gout patients. METHODS DECT of the hands, knees and feet were performed in patients with suspected gout using factory default gout settings, and colour-coded DECT lesions were registered. For each lesion, properties [mean density (mean of Hounsfield Units (HU) at 80 kV and Sn150kV), mean DECT ratio and size] and location were determined. Subgroup analysis was performed post hoc evaluating differences in locations of lesions when divided into definite MSU depositions and possibly other lesions. RESULTS In total, 4033 lesions were registered in 27 patients (23 gout patients, 3918 lesions; 4 non-gout patients, 115 lesions). In gout patients, lesions had a median density of 160.6 HU and median size of 6 voxels, and DECT ratios showed an approximated normal distribution (mean 1.06, SD 0.10), but with a right heavy tail consistent with the presence of smaller amounts of high effective atomic number lesions (e.g. calcium-containing lesions). The most common locations of lesions were 1st metatarsophalangeal (MTP1), knee and midtarsal joints along with quadriceps and patella tendons. Subgroup analyses showed that definite MSU depositions (large volume, low DECT ratio, high density) had a similar distribution pattern, whereas possible calcium-containing material (high DECT ratio) and non-gout MSU-imitating lesions (properties as definite MSU depositions in non-gout patients) were primarily found in some larger joints (knee, midtarsal and talocrural) and tendons (Achilles and quadriceps). MTP1 joints and patella tendons showed only definite MSU depositions. CONCLUSION Colour-coded DECT lesions in gout patients showed heterogeneity in properties and distribution. MTP1 joints and patella tendons exclusively showed definite MSU depositions. Hence, a sole focus on these regions in the evaluation of gout patients may improve the specificity of DECT scans.
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Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Felix Christoph Müller
- Department of Radiology, Herlev and Gentofte Hospital, Herlev, Denmark.,Siemens Healthineers, Ballerup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Slot
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark
| | - Jakob M Møller
- Department of Radiology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Henrik F Børgesen
- Department of Radiology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Huber FA, Gkoumas S, Thüring T, Becce F, Guggenberger R. Detection and Characterization of Monosodium Urate and Calcium Hydroxyapatite Crystals Using Spectral Photon-Counting Radiography: A Proof-of-Concept Study. Eur J Radiol 2020; 129:109080. [DOI: 10.1016/j.ejrad.2020.109080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 02/07/2023]
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Lu PL, Niu ZF, Qiu CW, Hu XY. Odontoid calcification and crowned dens syndrome: data from a Chinese center. Neurol Res 2020; 42:930-935. [PMID: 32657240 DOI: 10.1080/01616412.2020.1792700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess the prevalence of calcification surrounding the odontoid process (odontoid calcification) with crowned dens syndrome (CDS) and without CDS (non-CDS) and investigate factors that may related to the onset of CDS. METHODS Retrospective review of consecutive patients visited Sir Run Run Shaw Hospital between 1 January 2018 and 5 November 2019 who were identified to have odontoid calcification on cervical computed tomography (CT) images. Those who presented with an acute or subacute episode of cervico-occipital pain were defined as CDS, others were non-CDS. RESULTS We diagnosed 69 cases of odontoid calcification among 2902 cervical CTs of 2556 patients (69/2556, 2.70%), 19 (19/2556, 0.74%) cases of which were CDS, 50 (50/2556, 1.96%) cases were non-CDS. Mean age was 71 (54-86) years old in odontoid calcification patients. The male-to-female ratio of patients with odontoid calcification was 27:42 (0.64). The prevalence of odontoid calcification was 69/1497 (6.14%) in individuals over 50 years old, The prevalence was 0.59% (4/679), 5.05% (26/515), 11.49% (27/235) and 20% (12/60) in patients aged 50-59, 60-69, 70-79 and 80-89 years old, respectively. Age and female gender were predictive factors of odontoid calcification. Lower hemoglobin (Hgb), red blood cell count (RBC), higher C-reactive protein (CRP), pain scale score were found in CDS patients comparing with non-CDS group. No difference of age, gender, hypertension, diabetes mellitus, smoking, alcohol history, creatinine, white blood cell count, mean corpuscular volume, uric acid, calcium was found between the two groups. CONCLUSIONS Odontoid calcification is a common radiological entity in patients older than 50 years. Lower Hgb, RBC, higher CRP, pain scale score were found in CDS patients comparing with non-CDS.
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Affiliation(s)
- Pei-Lin Lu
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou, Zhejiang, China
| | - Zhong-Feng Niu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou, Zhejiang, China
| | - Chang-Wen Qiu
- Department of Neurology, Jinhua Wenlong Hospital , Jinhua, Zhejiang, China
| | - Xing-Yue Hu
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University , Hangzhou, Zhejiang, China
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Pascart T, Falgayrac G, Norberciak L, Lalanne C, Legrand J, Houvenagel E, Ea HK, Becce F, Budzik JF. Dual-energy computed-tomography-based discrimination between basic calcium phosphate and calcium pyrophosphate crystal deposition in vivo. Ther Adv Musculoskelet Dis 2020; 12:1759720X20936060. [PMID: 32636945 PMCID: PMC7315653 DOI: 10.1177/1759720x20936060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/30/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Dual-energy computed tomography (DECT) is being considered as a non-invasive diagnostic and characterization tool in calcium crystal-associated arthropathies. Our objective was to assess the potential of DECT in distinguishing between basic calcium phosphate (BCP) and calcium pyrophosphate (CPP) crystal deposition in and around joints in vivo. Methods: A total of 13 patients with calcific periarthritis and 11 patients with crystal-proven CPPD were recruited prospectively to undergo DECT scans. Samples harvested from BCP and CPP calcification types were analyzed using Raman spectroscopy and validated against synthetic crystals. Regions of interest were placed in BCP and CPP calcifications, and the following DECT attenuation parameters were obtained: CT numbers (HU) at 80 and 140 kV, dual-energy index (DEI), electron density (Rho), and effective atomic number (Zeff). These DECT attenuation parameters were compared and validated against crystal calibration phantoms at two known equal concentrations. Receiver operating characteristic (ROC) curves were plotted to determine the highest accuracy thresholds for DEI and Zeff. Results: Raman spectroscopy enabled chemical fingerprinting of BCP and CPP crystals both in vitro and in vivo. DECT was able to distinguish between HA and CPP in crystal calibration phantoms at two known equal concentrations, most notably by DEI (200 mg/cm3: 0.037 ± 0 versus 0.034 ± 0, p = 0.008) and Zeff (200 mg /cm3: 9.4 ± 0 versus 9.3 ± 0, p = 0.01) analysis. Likewise, BCP calcifications had significantly higher DEI (0.041 ± 0.005 versus 0.034 ± 0.005, p = 0.008) and Zeff (9.5 ± 0.2 versus 9.3 ± 0.2, p = 0.03) than CPP crystal deposits with comparable CT numbers in patients. With an area under the ROC curve of 0.83 [best threshold value = 0.0 39, sensitivity = 90. 9% (81.8, 97. 7%), specificity = 64.6% (50.0, 64. 6%)], DEI was the best parameter in distinguishing between BCP and CPP crystal depositions. Conclusion: DECT can help distinguish between crystal-proven BCP and CPP calcification types in vivo and, thus, aid in the diagnosis of challenging clinical cases, and in the characterization of CPP and BCP crystal deposition occurring in osteoarthritis.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals, Saint-Philibert Hospital, University of Lille, Rue du Grand But, Lomme, F-59160, France
| | - Guillaume Falgayrac
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, Lille, France
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Clément Lalanne
- Department of Orthopaedic Surgery, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Julie Legrand
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France
| | - Hang-Korng Ea
- Department of Rheumatology, Hôpital Lariboisière, AP-HP, Paris, France
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-François Budzik
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, Lille, France
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Simard M, Panta RK, Bell ST, Butler AP, Bouchard H. Quantitative imaging performance of MARS spectral photon‐counting CT for radiotherapy. Med Phys 2020; 47:3423-3434. [DOI: 10.1002/mp.14204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Mikaël Simard
- Département de physique Université de Montréal, Complexe des sciences 1375 Avenue Thérèse‐Lavoie‐Roux Montréal Québec H2V 0B3 Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal 900 Rue Saint‐Denis Montréal Québec H2X 3H8 Canada
| | - Raj Kumar Panta
- MARS Bioimaging Ltd Christchurch New Zealand
- Department of Radiology University of Otago Christchurch New Zealand
- European Organisation for Nuclear Research (CERN) Geneva Switzerland
| | | | - Anthony P.H. Butler
- MARS Bioimaging Ltd Christchurch New Zealand
- Department of Radiology University of Otago Christchurch New Zealand
- European Organisation for Nuclear Research (CERN) Geneva Switzerland
- School of Physical and Chemical Sciences University of Canterbury Christchurch New Zealand
| | - Hugo Bouchard
- Département de physique Université de Montréal, Complexe des sciences 1375 Avenue Thérèse‐Lavoie‐Roux Montréal Québec H2V 0B3 Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal 900 Rue Saint‐Denis Montréal Québec H2X 3H8 Canada
- Département de radio‐oncologie Centre hospitalier de l’Université de Montréal (CHUM) 1051 rue Sanguinet Montréal Québec H2X 3E4 Canada
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Falkowski AL, Jacobson JA, Kalia V, Meyer NB, Gandikota G, Yosef M, Thiele RG. Cartilage icing and chondrocalcinosis on knee radiographs in the differentiation between gout and calcium pyrophosphate deposition. PLoS One 2020; 15:e0231508. [PMID: 32298308 PMCID: PMC7162505 DOI: 10.1371/journal.pone.0231508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 12/27/2022] Open
Abstract
Objective To determine if findings of “cartilage icing" and chondrocalcinosis on knee radiography can differentiate between gout and calcium pyrophosphate deposition (CPPD). Methods IRB-approval was obtained and informed consent was waived for this retrospective study. Electronic medical records from over 2.3 million patients were searched for keywords to identify subjects with knee aspiration-proven cases of gout or CPPD. Radiographs were reviewed by two fellowship-trained musculoskeletal radiologists in randomized order, blinded to the patients’ diagnoses. Images were evaluated regarding the presence or absence of cartilage icing, chondrocalcinosis, tophi, gastrocnemius tendon calcification, and joint effusion. Descriptive statistics, sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. Results From 49 knee radiographic studies in 46 subjects (31 males and 15 females; mean age 66±13 years), 39% (19/49) showed gout and 61% (30/49) CPPD on aspiration. On knee radiographs, cartilage icing showed a higher sensitivity for CPPD than gout (53–67% and 26%, respectively). Chondrocalcinosis also showed a higher sensitivity for CPPD than gout (50–57% versus 5%), with 95% specificity and 94% positive predictive value for diagnosis of CPPD versus gout. Soft tissue tophus-like opacities were present in gout at the patellar tendon (5%, 1/19) and at the popliteus groove in CPPD (15%, 4/27). Gastrocnemius tendon calcification was present in 30% (8/27) of subjects with CPPD, and 5% (1/19) of gout. Conclusion In subjects with joint aspiration-proven crystal disease of the knee, the radiographic finding of cartilage icing was seen in both gout and CPPD. Chondrocalcinosis (overall and hyaline cartilage) as well as gastrocnemius tendon calcification positively correlated with the diagnosis of CPPD over gout.
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Affiliation(s)
- Anna L. Falkowski
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
- * E-mail:
| | - Jon A. Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Vivek Kalia
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Nathaniel B. Meyer
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Girish Gandikota
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matheos Yosef
- Michigan Institute for Clinical & Health Research (MICHR), Ann Arbor, MI, United States of America
| | - Ralf G. Thiele
- Department of Rheumatology, University of Rochester, Rochester, New York, United States of America
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Filippou G, Pascart T, Iagnocco A. Utility of Ultrasound and Dual Energy CT in Crystal Disease Diagnosis and Management. Curr Rheumatol Rep 2020; 22:15. [PMID: 32291581 DOI: 10.1007/s11926-020-0890-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The objective of this review is to critically discuss the latest evidence on the use of ultrasound and dual energy computed tomography (DECT) for the assessment of microcrystalline arthritis. RECENT FINDINGS Both techniques have been included in the classification and diagnostic criteria for gout, while only ultrasound appears in the diagnostic recommendations for CPPD. Regarding the management of the diseases, there is encouraging evidence for the use of both techniques for the follow-up of gout patients, while very few or null data are available for CPPD. Ultrasound has been adequately validated for the diagnosis of CPPD, while some issues have still to be clarified regarding gout. DECT has also demonstrated to be accurate for gout diagnosis, but very few data are available regarding CPPD. Future research should aim to improve the reliability of both techniques and to create scoring systems for a more accurate follow-up of patients.
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Affiliation(s)
- Georgios Filippou
- Department of Medical Sciences, Section of rheumatology, Azienda ospedaliero-Universitaria Sant'Anna di Cona, University of Ferrara, via Aldo Moro, Ferrara, Italy
| | - Tristan Pascart
- Department of Rheumatology, Hôpital Saint-Philibert, Université Catholique de Lille, Lille, France
| | - Annamaria Iagnocco
- Dipartimento Scienze Cliniche e Biologiche, Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy.
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Winds of change in imaging of calcium crystal deposition diseases. Joint Bone Spine 2019; 86:665-668. [DOI: 10.1016/j.jbspin.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/17/2019] [Indexed: 12/26/2022]
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Affiliation(s)
- Jasvinder A Singh
- University of Alabama at Birmingham, Birmingham, AL, USA. .,Birmingham VA Medical Center, Birmingham, AL, USA.
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Abstract
PURPOSE OF REVIEW This paper covers confusion and challenges in the nomenclature of calcium pyrophosphate deposition disease. Clinicians, investigators, and patients are faced with a variety of terms that are used to describe CPPD and its phenotypes, and clarity is greatly needed to help advance research and patient care. Motivation for the upcoming development of CPPD classification criteria is reviewed. RECENT FINDINGS EULAR proposed recommended terminology for CPPD in 2011. International Classification of Diseases (ICD-9 and ICD-10) billing codes identify definite or probable CPPD with variable accuracy depending on the clinical setting and comparator group. READ diagnostic codes have been employed to identify pseudogout in UK datasets but their accuracy has not been evaluated. CPPD classification criteria will provide a system for identifying a relatively homogenous group of patients to be included in clinical studies, enabling comparison of outcomes across studies. CPPD nomenclature remains challenging for clinicians, investigators, and patients. A lay-friendly definition of CPPD, using easily accessible terminology, would be welcome. CPPD classification criteria are a necessary step in moving forward CPPD clinical research and may involve a range of clinical, laboratory, and imaging modalities.
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Affiliation(s)
- Sara K Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA.
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Dalbeth N, Frampton C, Fung M, Baumgartner S, Nicolaou S, Choi HK. Concurrent validity of provisional remission criteria for gout: a dual-energy CT study. Arthritis Res Ther 2019; 21:150. [PMID: 31227018 PMCID: PMC6588898 DOI: 10.1186/s13075-019-1941-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background Provisional gout remission criteria including five domains (serum urate, tophus, flares, pain due to gout, and patient global assessment) have been proposed. The aim of this study was to test the concurrent validity of the provisional gout remission criteria by comparing the criteria with dual-energy CT (DECT) findings. Methods Patients with gout on allopurinol ≥ 300 mg daily were prospectively recruited into a multicenter DECT study. Participants attended a standardized study visit which recorded gout flare frequency in the preceding 12 months, physical examination for tophus, serum urate, and patient questionnaires. DECT scans of both hands/wrists, feet/ankles/Achilles, and knees were analyzed by two DECT radiologists. The relationship between the DECT urate crystal volume and deposition with individual domains as well as the provisional remission criteria set was analyzed. Results The provisional remission criteria were fulfilled in 23 (15.1%) participants. DECT urate crystal deposition was observed less frequently in those fulfilling the provisional remission criteria (44%), compared with those not fulfilling the criteria (73.6%, odds ratio 0.28, P = 0.004). The median (range) DECT urate crystal volume was 0.00 (0.00–0.46) cm3 for those fulfilling the remission criteria, compared with 0.08 (0.00–19.53) cm3 for those not fulfilling the criteria (P = 0.002). In multivariate regression analysis, the serum urate and tophus domains were most strongly associated with DECT urate crystal deposition. Conclusions In people with gout established on allopurinol, a state of remission as defined by the provisional remission criteria is associated with less DECT urate crystal deposition. While this study provides support for the validity of the provisional gout remission criteria, it also demonstrates that some crystal deposition may be present in people achieving these criteria. Electronic supplementary material The online version of this article (10.1186/s13075-019-1941-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand.
| | | | - Maple Fung
- Formerly Ardea Biosciences, Inc., San Diego, CA, USA
| | | | - Savvas Nicolaou
- Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Hyon K Choi
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
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Hajri R, Hajdu SD, Hügle T, Zufferey P, Guiral L, Becce F. Dual‐Energy Computed Tomography for the Noninvasive Diagnosis of Coexisting Gout and Calcium Pyrophosphate Deposition Disease. Arthritis Rheumatol 2019; 71:1392. [DOI: 10.1002/art.40907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Rami Hajri
- Lausanne University Hospital and University of Lausanne
| | | | - Thomas Hügle
- Lausanne University Hospital and University of Lausanne
| | | | | | - Fabio Becce
- Lausanne University Hospital and University of Lausanne Lausanne Switzerland
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