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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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Khayata K, Diekhoff T, Mews J, Schmolke S, Kotlyarov M. Virtual noncontrast images reveal gouty tophi in contrast-enhanced dual-energy CT: a phantom study. Eur Radiol Exp 2024; 8:69. [PMID: 38862843 PMCID: PMC11166610 DOI: 10.1186/s41747-024-00466-w] [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: 01/22/2024] [Accepted: 04/08/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Dual-energy computed tomography (DECT) is useful for detecting gouty tophi. While iodinated contrast media (ICM) might enhance the detection of monosodium urate crystals (MSU), higher iodine concentrations hamper their detection. Calculating virtual noncontrast (VNC) images might improve the detection of enhancing tophi. The aim of this study was to evaluate MSU detection with VNC images from DECT acquisitions in phantoms, compared against the results with standard DECT reconstructions. METHODS A grid-like and a biophantom with 25 suspensions containing different concentrations of ICM (0 to 2%) and MSU (0 to 50%) were scanned with sequential single-source DECT using an ascending order of tube current time product at 80 kVp (16.5-220 mAs) and 135 kVp (2.75-19.25 mAs). VNC images were equivalently reconstructed at 80 and 135 kVp. Two-material decomposition analysis for MSU detection was applied for the VNC and conventional CT images. MSU detection and attenuation values were compared in both modalities. RESULTS For 0, 0.25, 0.5, 1, and 2% ICM, the average detection indices (DIs) for all MSU concentrations (35-50%) with VNC postprocessing were respectively 25.2, 36.6, 30.9, 38.9, and 45.8% for the grid phantom scans and 11.7, 9.4, 5.5, 24.0, and 25.0% for the porcine phantom scans. In the conventional CT image group, the average DIs were respectively 35.4, 54.3, 45.4, 1.0, and 0.0% for the grid phantom and 19.4, 17.9, 3.0, 0.0, and 0.0% for the porcine phantom scans. CONCLUSIONS VNC effectively reduces the suppression of information caused by high concentrations of ICM, thereby improving the detection of MSU. RELEVANCE STATEMENT Contrast-enhanced DECT alone may suffice for diagnosing gout without a native acquisition. KEY POINTS • Highly concentrated contrast media hinders monosodium urate crystal detection in CT imaging • Virtual noncontrast imaging redetects monosodium urate crystals in high-iodinated contrast media concentrations. • Contrast-enhanced DECT alone may suffice for diagnosing gout without a native acquisition.
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Affiliation(s)
- Karim Khayata
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Jürgen Mews
- Canon Medical Systems, Europe BV, Zoetermeer, The Netherlands
| | - Sydney Schmolke
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Maximilian Kotlyarov
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, 10117, Germany
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Abu-Omar A, Murray N, Ali IT, Khosa F, Barrett S, Sheikh A, Nicolaou S, Tamburrini S, Iacobellis F, Sica G, Granata V, Saba L, Masala S, Scaglione M. Utility of Dual-Energy Computed Tomography in Clinical Conundra. Diagnostics (Basel) 2024; 14:775. [PMID: 38611688 PMCID: PMC11012177 DOI: 10.3390/diagnostics14070775] [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: 01/29/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Advancing medical technology revolutionizes our ability to diagnose various disease processes. Conventional Single-Energy Computed Tomography (SECT) has multiple inherent limitations for providing definite diagnoses in certain clinical contexts. Dual-Energy Computed Tomography (DECT) has been in use since 2006 and has constantly evolved providing various applications to assist radiologists in reaching certain diagnoses SECT is rather unable to identify. DECT may also complement the role of SECT by supporting radiologists to confidently make diagnoses in certain clinically challenging scenarios. In this review article, we briefly describe the principles of X-ray attenuation. We detail principles for DECT and describe multiple systems associated with this technology. We describe various DECT techniques and algorithms including virtual monoenergetic imaging (VMI), virtual non-contrast (VNC) imaging, Iodine quantification techniques including Iodine overlay map (IOM), and two- and three-material decomposition algorithms that can be utilized to demonstrate a multitude of pathologies. Lastly, we provide our readers commentary on examples pertaining to the practical implementation of DECT's diverse techniques in the Gastrointestinal, Genitourinary, Biliary, Musculoskeletal, and Neuroradiology systems.
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Affiliation(s)
- Ahmad Abu-Omar
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Nicolas Murray
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Ismail T. Ali
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Faisal Khosa
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Sarah Barrett
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Adnan Sheikh
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Savvas Nicolaou
- Department of Emergency Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada (I.T.A.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy;
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS Di Napoli, 80131 Naples, Italy
| | - Luca Saba
- Medical Oncology Department, AOU Cagliari, Policlinico Di Monserrato (CA), 09042 Monserrato, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy; (S.M.)
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy; (S.M.)
- Department of Radiology, Pineta Grande Hospital, 81030 Castel Volturno, Italy
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
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Cheong SCW, Yan YY, Sheikh A, Ouellette HA, Munk PL, Murray N, Mallinson PI. Dual-energy CT applications in musculoskeletal disorders. Br J Radiol 2024; 97:705-715. [PMID: 38291893 PMCID: PMC11027318 DOI: 10.1093/bjr/tqae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/06/2024] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
Dual-energy CT (DECT) is an exciting application in CT technology conferring many advantages over conventional single-energy CT at no additional with comparable radiation dose to the patient. Various emerging and increasingly established clinical DECT applications in musculoskeletal (MSK) imaging such as bone marrow oedema detection, metal artefact reduction, monosodium urate analysis, and collagen analysis for ligamentous, meniscal, and disc injuries are made possible through its advanced DECT post-processing capabilities. These provide superior information on tissue composition, artefact reduction and image optimization. Newer DECT applications to evaluate fat fraction for sarcopenia, Rho/Z application for soft tissue calcification differentiation, 3D rendering, and AI integration are being assessed for future use. In this article, we will discuss the established and developing applications of DECT in the setting of MSK radiology as well as the basic principles of DECT which facilitate them.
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Affiliation(s)
- Sook Chuei W Cheong
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
- Department of Radiology, Changi General Hospital, Singapore 529889, Singapore
| | - Yet Yen Yan
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
- Department of Radiology, Changi General Hospital, Singapore 529889, Singapore
| | - Adnan Sheikh
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Hugue A Ouellette
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Peter L Munk
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Nicolas Murray
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
| | - Paul I Mallinson
- Musculoskeletal section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9 Canada
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Klauser AS, Strobl S, Schwabl C, Kremser C, Klotz W, Vasilevska Nikodinovska V, Stofferin H, Scharll Y, Halpern E. Impact of Dual-Energy Computed Tomography (DECT) Postprocessing Protocols on Detection of Monosodium Urate (MSU) Deposits in Foot Tendons of Cadavers. Diagnostics (Basel) 2023; 13:2208. [PMID: 37443602 DOI: 10.3390/diagnostics13132208] [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: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To evaluate two different dual-energy computed tomography (DECT) post-processing protocols for the detection of MSU deposits in foot tendons of cadavers with verification by polarizing light microscopy as the gold standard. MATERIAL AND METHODS A total of 40 embalmed cadavers (15 male; 25 female; median age, 82 years; mean, 80 years; range, 52-99; SD ± 10.9) underwent DECT to assess MSU deposits in foot tendons. Two postprocessing DECT protocols with different Hounsfield unit (HU) thresholds, 150/500 (=established) versus 120/500 (=modified). HU were applied to dual source acquisition with 80 kV for tube A and 140 kV for tube B. Six fresh cadavers (4 male; 2 female; median age, 78; mean, 78.5; range 61-95) were examined by DECT. Tendon dissection of 2/6 fresh cadavers with positive DECT 120 and negative DECT 150 studies were used to verify MSU deposits by polarizing light microscopy. RESULTS The tibialis anterior tendon was found positive in 57.5%/100% (DECT 150/120), the peroneus tendon in 35%/100%, the achilles tendon in 25%/90%, the flexor halluces longus tendon in 10%/100%, and the tibialis posterior tendon in 12.5%/97.5%. DECT 120 resulted in increased tendon MSU deposit detection, when DECT 150 was negative, with an overall agreement between DECT 150 and DECT 120 of 80% (p = 0.013). Polarizing light microscope confirmed MSU deposits detected only by DECT 120 in the tibialis anterior, the achilles, the flexor halluces longus, and the peroneal tendons. CONCLUSION The DECT 120 protocol showed a higher sensitivity when compared to DECT 150.
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Affiliation(s)
| | - Sylvia Strobl
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Schwabl
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christian Kremser
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Werner Klotz
- Department of Internal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Violeta Vasilevska Nikodinovska
- University Surgical Clinic "St. Naum Ohridski", Faculty of Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Hannes Stofferin
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Yannick Scharll
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ethan Halpern
- Jefferson Prostate Diagnostic and Kimmel Cancer Center, Department of Radiology and Urology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Yoon H, Kang Y, Kim HJ, Lee E, Ahn JM, Lee JW. Dual-layer spectral detector CT arthrography of the shoulder: assessment of image quality and value in differentiating calcium from iodine. Acta Radiol 2023; 64:638-647. [PMID: 35300534 DOI: 10.1177/02841851221087991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dual-layer spectral detector computed tomography (DLCT) may potentially improve CT arthrography through enhanced image quality and analysis of the chemical composition of tissue. PURPOSE To evaluate the image quality of monoenergetic reconstructions from DLCT arthrography of the shoulder and assess the additional diagnostic value in differentiating calcium from iodine. MATERIAL AND METHODS Images from consecutive shoulder DLCT arthrography examinations performed between December 2016 and February 2018 were retrospectively reviewed for hyperattenuating lesions within the labrum and tendons. The mean attenuation of the target lesion, noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of the virtual monoenergetic images obtained at 40-200 keV were compared with conventional 140-kVp images. Two evaluators independently classified each target lesion as contrast media or calcification, without and with DLCT spectral data. Receiver operating curve (ROC) analysis was performed to assess the diagnostic performance of shoulder DLCT arthrography, without and with the aid of spectral data. RESULTS The study included 20 target lesions (18 DLCT arthrography examinations of 17 patients). The SNRs of the monoenergetic images at 40-60 keV were significantly higher than those of conventional images (P < 0.05). The CNRs of the monoenergetic images at 40-70 keV were significantly higher than those of conventional images (P < 0.001). The ability to differentiate calcium from iodine, without and with DLCT spectral data, did not significantly differ (P = 0.441 and P = 0.257 for reviewers 1 and 2, respectively). CONCLUSION DLCT had no additive value in differentiating calcium from iodine in small, hyperattenuating lesions in the labrum and tendons.
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Affiliation(s)
- Hyeyoung Yoon
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyo Jin Kim
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 65633Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eugene Lee
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Imaging of Crystal Disorders:: Calcium Pyrophosphate Dihydrate Crystal Deposition Disease, Calcium Hydroxyapatite Crystal Deposition Disease and Gout Pathophysiology, Imaging, and Diagnosis. Radiol Clin North Am 2022; 60:641-656. [PMID: 35672096 DOI: 10.1016/j.rcl.2022.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Crystal arthropathies are a group of joint disorders due to deposition of crystals in and around joints that lead to joint destruction and soft tissue masses. Clinical presentation is variable and diagnosis might be challenging. In this article the pathophysiology is addressed, the preferred deposition of crystal arthropathies and imaging findings. Case studies of calcium pyrophosphate dihydrate crystal deposition disease, hydroxyapatite crystal deposition disease, and gout are shown. Guidelines for the use of dual-energy computed tomography are given to enable the diagnosis and follow-up of gout.
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Huang Z, Li Z, Xiao J, Xie Y, Hu Y, Zhang S, Wang X. Dual-energy computed tomography for the diagnosis of acute gouty arthritis. Curr Med Imaging 2021; 18:305-311. [PMID: 34238168 DOI: 10.2174/1573405617666210707164124] [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: 02/08/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022]
Abstract
AIMS To investigate the diagnostic value of dual-energy computed tomography (DECT) in acute gouty arthritis (AGA) or patients presenting with suspected gouty arthritis. METHODS This retrospective study was performed in a single centre from May 2017 to August 2018. Two hundred and twenty-six patients with an initial diagnosis of AGA in the preceding 15 days were included. All patients were referred for a DECT scan of the affected joints. The diagnosis criteria of gout with the American College of Rheumatology Classification Standard were regarded as the reference standard. RESULTS Two hundred patients were included in the present study at last. The sensitivity, specificity, positive predictive value, and negative predictive value of DECT in the diagnosis of all AGA were 83.83%, 60.61%, 91.5% and 42.55% respectively. When AGA was subdivided according to the joint site, the sensitivity, specificity, positive predictive value, and negative predictive value were 80.68%, 61.11%, 91.03%, and 39.29% in feet, 93.55%, 40%, 93.55%, and 40% in knees and 87.5%, 71.43%, 91.3%, and 62.5% in ankles, respectively. CONCLUSIONS DECT had a high sensitivity for the diagnosis of AGA. However, the specificity was limited, particularly for the diagnosis of acute gouty knee arthritis. Prospective multicenter studies of large samples will enhance the application of DECT among the AGA patients in the future.
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Affiliation(s)
- Zengfa Huang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, Hubei 430014, China
| | - Zuoqin Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, Hubei 430014, China
| | - Jianwei Xiao
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, Hubei 430014, China
| | - Yuanliang Xie
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, Hubei 430014, China
| | - Yun Hu
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, Hubei 430014, China
| | - Shutong Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, Hubei 430014, China
| | - Xiang Wang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, Hubei 430014, China
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Yue X, Jiang Q, Hu X, Cen C, Song S, Qian K, Lu Y, Yang M, Li Q, Han P. Quantitative dual-energy CT for evaluating hepatocellular carcinoma after transarterial chemoembolization. Sci Rep 2021; 11:11127. [PMID: 34045528 PMCID: PMC8160271 DOI: 10.1038/s41598-021-90508-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/10/2021] [Indexed: 02/08/2023] Open
Abstract
We aimed to investigate the role of the quantitative parameters of dual-energy computed tomography (DECT) in evaluating patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). We retrospectively identified 80 HCC patients (mean age, 56 years; 61 men) treated by TACE who received contrast-enhanced DECT and were retreated by TACE within 7 days between November 2018 and December 2019. Taking digital subtraction angiography (DSA) and CT images as reference standard, two readers measured and calculated the values of normalized iodine concentration at arterial phase (NICAP), normalized iodine concentration at portal venous phase (NICPP), iodine concentration difference (ICD), arterial iodine fraction (AIF) and slope of the spectral Hounsfield unit curve (λHu) by placing matched regions of interests (ROIs) within the tumor active area (TAA), adjacent normal hepatic parenchyma (ANHP) and tumor necrotic area (TNA). Differences between the parameters were analyzed by the Kruskal-Wallis H test. Receiver operating characteristic analysis of the parameters performance in differentiating the three tissues types was performed. AIF exhibited a good performance in distinguishing TAA (0.93 ± 0.31) and ANHP (0.18 ± 0.14), the areas under the receiver operating characteristic curve (AUC) was 0.989, while the λHu exhibited an excellent performance in distinguishing TAA (3.32 ± 1.24) and TNA (0.29 ± 0.27), with an AUC of 1.000. In conclusion, quantitative DECT can be effectively used to evaluate the tumor viability in HCC patients treated by TACE.
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Affiliation(s)
- Xiaofei Yue
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qiqi Jiang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xuehan Hu
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chunyuan Cen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Songlin Song
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Kun Qian
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yuting Lu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Ming Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qian Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Kotlyarov M, Hermann KGA, Mews J, Hamm B, Diekhoff T. Dual-energy computed tomography: Tube current settings and detection of uric acid tophi. Eur J Radiol 2021; 139:109692. [PMID: 33839428 DOI: 10.1016/j.ejrad.2021.109692] [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: 01/15/2021] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To derive optimal scanning parameters for single-source dual-energy computed tomography (DECT) in the detection of urate by analyzing influence of tube current ratio (TCR) and total radiation exposure in a phantom. METHOD Specimens with different urate concentrations in a realistic porcine bio-phantom were repeatedly imaged with sequential single-source DECT scans at 80 kVp (16.5-220 mA s) and 135 kVp (2.75-19.25 mA s). Detection index (DI - true positive minus false positive urate volume) was calculated for every possible tube current combination. Optimal tube current combinations reaching at least 85 % of the highest measured DI of all combinations without exceeding 150 % of equivalent single-energy radiation dose were identified. TCR, DLP and DI were plotted and compared. RESULTS Cubic regression analysis showed a flattening increase in the DI with increasing tube currents. Five out of the 100 tube current combinations analyzed achieved the detection target: the lowest DLP of 53.9 mGy*cm at 19.25/16.5 mAs (135/80 kVp) achieved a DI of 2.07 mL and the highest DI of 2.11 mL at a dose of 65.3 mGy*cm and 8.25/79.75 mAs. The optimal TCR is between two and four, while both, higher and lower ratios decreased DI. CONCLUSIONS A minimum tube current of the high-energy scans is needed before an acceptable overall sensitivity is achieved and before increases in low-energy exposure result in more urate detection. High TCRs above 10 are not beneficial while the optimal TCR ranges between two and four, indicating that special care has to be taken in designing a suitable DECT protocol.
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Affiliation(s)
- Maximilian Kotlyarov
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Kay Geert A Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jürgen Mews
- Canon Medical Systems, Europe BV, Zilverstraat 1, 2718 RP, Zoetermeer, Netherlands
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Ziegeler K, Eshed I, Diekhoff T, Hermann KG. Imaging of Joints and Bones in Autoinflammation. J Clin Med 2020; 9:E4074. [PMID: 33348664 PMCID: PMC7766736 DOI: 10.3390/jcm9124074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022] Open
Abstract
Autoinflammatory disorders are commonly characterized by seemingly unprovoked systemic inflammation mainly driven by cells and cytokines of the innate immune system. In many disorders on this spectrum, joint and bone involvement may be observed and imaging of these manifestations can provide essential diagnostic information. This review aimed to provide a comprehensive overview of the imaging characteristics for major diseases and disease groups on the autoinflammatory spectrum, including familial Mediterranean fever (FMF), Behçet disease (BD), crystal deposition diseases (including gout), adult-onset Still's disease (AoSD), and syndromatic synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO)/chronic recurrent multifocal osteomyelitis (CRMO). Herein, we discuss common and distinguishing imaging characteristics, phenotypical overlaps with related diseases, and promising fields of future research.
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Affiliation(s)
- Katharina Ziegeler
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (T.D.); (K.G.H.)
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Giborim Affiliated with the Sackler School of Medicine, Tel Aviv University, 52621 Tel Aviv, Israel;
| | - Torsten Diekhoff
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (T.D.); (K.G.H.)
| | - Kay Geert Hermann
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (T.D.); (K.G.H.)
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Wang JX, Ng B, Bak H, Spencer D, Manolios N, Wong PKK. The utility of dual energy computed tomography in the management of axial gout: case reports and literature review. BMC Rheumatol 2020; 4:22. [PMID: 32411925 PMCID: PMC7206789 DOI: 10.1186/s41927-020-00119-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022] Open
Abstract
Background Severe spinal pain is an unusual presentation of gout. Due to its rarity and the difficulty of obtaining joint fluid or tissue for crystal analysis, dual energy computed tomography (DECT) may be a useful imaging modality in the management of axial gout. Case presentation Two patients independently presented to a major teaching hospital with severe spinal pain subsequently shown to be due to gout. The first patient presented with back pain and fevers and was initially thought to have lumbar facet joint septic arthritis. The second case presented with severe back pain. In both cases, DECT suggested monosodium urate deposition in spinal tissues as the cause of their presentation. Conclusions Axial gout should be considered in the differential diagnosis of severe spinal pain. A DECT study may be a useful diagnostic tool in the management of spinal gout.
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Affiliation(s)
- Jeremy X Wang
- 1Department of Rheumatology, Westmead Hospital, Westmead, Sydney, NSW 2145 Australia
| | - Beverly Ng
- 1Department of Rheumatology, Westmead Hospital, Westmead, Sydney, NSW 2145 Australia
| | - Haesung Bak
- 1Department of Rheumatology, Westmead Hospital, Westmead, Sydney, NSW 2145 Australia
| | - David Spencer
- 1Department of Rheumatology, Westmead Hospital, Westmead, Sydney, NSW 2145 Australia.,2Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Nicholas Manolios
- 1Department of Rheumatology, Westmead Hospital, Westmead, Sydney, NSW 2145 Australia.,2Sydney Medical School, University of Sydney, Sydney, NSW Australia
| | - Peter K K Wong
- 1Department of Rheumatology, Westmead Hospital, Westmead, Sydney, NSW 2145 Australia.,3Rural Clinical School, Coffs Harbour, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value? Skeletal Radiol 2020; 49:707-713. [PMID: 31802167 DOI: 10.1007/s00256-019-03343-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the ability of dual-energy computed tomography (DECT) to improve diagnostic discrimination between gout and other crystal arthropathies such as calcium pyrophosphate deposition disease (CPPD) of the wrist in a clinical patient population. MATERIALS AND METHODS This retrospective case-control study included 29 patients with either gout (case group; n = 9) or CPPD (control group; n = 20) who underwent DECT of the wrist for clinically suspected crystal arthropathy. Color-coded urate and enhanced calcium as well as virtual 120 kVe blended images were reconstructed from the DECT datasets. Two independent and blinded readers evaluated each reconstructed dataset for the presence of depositions in 17 predefined regions. Additionally, a global diagnosis was made first for 120 kVe images only, based solely on morphologic criteria, and subsequently for all reconstructed images. RESULTS Sensitivity for the global diagnosis of gout was 1.0 (95% CI 0.63-1) for both DECT and 120 kVe images with specificities of 0.70 (95% CI 0.46-0.87) for DECT and 0.80 (95% CI 0.56-0.93) for 120 kVe images. Color-coded DECT images did not detect more depositions than monochrome standard CT images. CONCLUSION Discrimination of crystal arthropathies of the wrist is limited using DECT and primarily relying on color-coded images. Evaluation of morphologic criteria on standard CT images is essential for accurate diagnosis.
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Zhang B, Yang M, Wang H. Diagnostic value of ultrasound versus dual-energy computed tomography in patients with different stages of acute gouty arthritis. Clin Rheumatol 2020; 39:1649-1653. [PMID: 32157468 DOI: 10.1007/s10067-020-05014-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/19/2020] [Accepted: 02/28/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous studies of the diagnostic accuracy of ultrasound (US) and dual-energy computed tomography (DECT) in patients with gout have reported different results. The aim of this study is to compare the diagnostic value of US and DECT in patients with different stages of acute gouty arthritis. METHODS Based on the presence of monosodium urate (MSU) crystals in the synovial fluid, patients (n = 37) were divided into three groups according to gout duration: early stage (within 1 year, n = 15), middle stage (1 to 3 years, n = 12), and late stage (more than 3 years, n = 10). All the affected joints were examined by US and DECT. RESULTS In the early-stage group, the sensitivity of US was significantly higher than DECT in identifying MSU deposition (66.7% vs 26.6%, p < 0.05), while in the middle- and late-stage groups, the sensitivity of US and DECT was similar. In the early-stage group, the US results in nine joints were positive (four with double contour sign, four with snowstorm sign, and one with both double contour sign and snowstorm sign), while DECT did not show any urate crystal deposits. CONCLUSION These findings indicate that US should be the first choice for acute gouty arthritis, especially in patients with early-stage disease.Key Points• Previous studies have compared DECT with US to evaluate the reliability of each method in diagnosing gout but have reported different results, which may be partly due to different gout duration.• In our study, the sensitivity of US was significantly higher than DECT in identifying MSU deposition in the early-stage group, while in the middle- and late-stage groups, the sensitivity of US and DECT was similar.• US should be the first choice for the diagnosis of acute gouty arthritis, especially in patients with early-stage disease.
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Affiliation(s)
- Bin Zhang
- Department of Rheumatology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, 314000, Zhejiang, China
| | - Mingfeng Yang
- Department of Rheumatology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, 314000, Zhejiang, China
| | - Hongzhi Wang
- Department of Rheumatology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, 314000, Zhejiang, China.
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Impact of Dual-Energy CT Postprocessing Protocol for the Detection of Gouty Arthritis and Quantification of Tophi in Patients Presenting With Podagra: Comparison With Ultrasound. AJR Am J Roentgenol 2019; 213:1315-1323. [PMID: 31553656 DOI: 10.2214/ajr.19.21404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The objective of our study was to compare ultrasound (US) tophus and monosodium urate (MSU) deposit detection and US tophus size in the metatarsophalangeal (MTP) 1 joint with dual-energy CT (DECT) using two DECT postprocessing protocols in patients presenting with podagra. SUBJECTS AND METHODS. Seventy-five consecutive patients with podagra (66 men and nine women; mean age, 65.6 years; age range, 33-88 years) and 75 control subjects with MTP 1 joint osteoarthritis (49 men and 26 women; mean age, 63.0 years; age range, 35-87 years) prospectively underwent US and DECT between 2016 and 2018 to assess the MTP 1 joint. Two Syngovia postprocessing DECT protocols with different minimum attenuation thresholds of 150 HU (DECT 150 protocol) versus 120 HU (DECT 120 protocol) and the same maximum attenuation threshold (500 HU) and constant kilovoltage setting of tubes A and B at 80 and 140 kVp were evaluated. Interobserver variability of the two DECT protocols was calculated and compared with that of US. RESULTS. The postprocessing DECT 150 protocol was positive for tophus detection in 55 of 75 patients (73.3%) with podagra, whereas the postprocessing DECT 120 protocol detected MSU deposits in all 75 patients (100%). Tophus size assessed using the DECT 120 protocol showed an improved correlation with tophus size detected on US (p < 0.01). Interobserver variability of DECT was improved when using the DECT 120 protocol (p < 0.01). CONCLUSION. The postprocessing DECT 120 protocol enables improved visualization of MSU deposits and provides more accurate information about tophus size that better correlates with tophus size on US compared with the standard postprocessing DECT 150 protocol.
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Dual-Energy CT in Musculoskeletal Imaging: What Is the Role Beyond Gout? AJR Am J Roentgenol 2019; 213:493-505. [DOI: 10.2214/ajr.19.21095] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Yokose C, Dalbeth N, Wei J, Nicolaou S, Simeone FJ, Baumgartner S, Fung M, Zhang Y, Choi HK. Radiologic evidence of symmetric and polyarticular monosodium urate crystal deposition in gout - A cluster pattern analysis of dual-energy CT. Semin Arthritis Rheum 2019; 50:54-58. [PMID: 31371194 DOI: 10.1016/j.semarthrit.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/13/2019] [Accepted: 07/10/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the clustering patterns of monosodium urate (MSU) crystal deposition and bone erosions among patients with gout requiring urate-lowering therapy (ULT) using dual-energy CT (DECT). METHODS DECT scans of bilateral hands/wrists, feet/ankles, and knees were obtained on 153 patients with gout on allopurinol ≥300 mg daily for ≥3 months. Two radiologists assessed the images at pre-specified sites (15 in the hands/wrists, 12 in the feet/ankles, 4 in the knees). Clustering patterns of MSU crystal deposition and bone erosions were evaluated. RESULTS Among 153 patients with gout (mean duration, 15 years) on allopurinol (mean duration, 5 years), MSU crystal deposition (67%) affected multiple sites in the hands/wrists, feet/ankles, and knees more often than would be expected by chance (p<0.001 for all 3 regions). In the feet/ankles, bone erosions were also observed in a clustered manner (p<0.001). Presence of MSU crystal deposition at a particular joint was most strongly associated with symmetric involvement of the same joint of the opposite extremity in the hands/wrists, feet/ankles, and knees (adjusted odds ratio (OR) 26.1, 46.9, and 9.9, respectively). Similarly, presence of erosions in the feet/ankles was highly symmetric (adjusted OR 91.4). Erosions were 8-fold more likely to be present in sites with MSU crystal deposition compared to those without. CONCLUSION Among patients with longstanding gout on ULT, MSU crystal deposition and bone erosions affect multiple joints within the hands/wrists, feet/ankles, and knees in a highly symmetric manner. These radiologic data support the notion of MSU crystal deposition in gout as a symmetric polyarthropathy.
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Affiliation(s)
- Chio Yokose
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Jie Wei
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
| | - F Joseph Simeone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Maple Fung
- Formerly Ardea Biosciences Inc., San Diego, California, USA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA
| | - Hyon K Choi
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA.
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Carotti M, Salaffi F, Beci G, Giovagnoni A. The application of dual-energy computed tomography in the diagnosis of musculoskeletal disorders: a review of current concepts and applications. Radiol Med 2019; 124:1175-1183. [DOI: 10.1007/s11547-019-01015-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
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Wang Y, Deng X, Xu Y, Ji L, Zhang Z. Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography: A cross-sectional study in patients with clinically diagnosed gout. Medicine (Baltimore) 2018; 97:e12834. [PMID: 30334984 PMCID: PMC6211858 DOI: 10.1097/md.0000000000012834] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/21/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of our study was to compare the performance of ultrasonography (US) and dual-energy computed tomography (DECT) in detecting the crystal deposition at lower extremity joints in patients with gout. The correlation of imaging findings with microscopic findings was further assessed whenever aspiration is available.We recruited consecutive patients who were presented with arthritis of lower extremity from January 2012 to December 2014. All the patients underwent DECT and US scan of bilateral knees, ankles, and feet. Synovial fluid was obtained by aspiration from an acute inflammatory joint if possible.Finally, 60 patients fulfilling the 1977 gout classification criteria were included in our study. We found that US can detect significantly more patients with crystal deposition than DECT (81.7% vs 56.7%, by US and DECT, respectively, P < .001). The frequency of urate crystal deposition detected by US at MTP1, knee, and ankle joints regions was 56.7%, 63.3%, and 51.7%, respectively. The percentage of positivity of double contour sign on US was 33.3%, 48.3%, and 41.7% at the joints mentioned above, respectively. There was a good correlation between ultrasound and synovial fluid analysis in detecting crystal deposition (κ = 0.87, P = .001), while the agreement between DECT and synovial fluid analysis was just fair (κ = 0.28, P = .02).The sensitivity of US in detecting urate crystal deposition in lower extremity joints was higher than DECT. The superiority was more obvious in knee and MTP1 joints. US should be considered as the first choice of image examinations when diagnosing gout.
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Affiliation(s)
- Yu Wang
- Department of Rheumatology and Clinical Immunology
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology
| | - Yufeng Xu
- Department of Radiology, Peking University First Hospital, Beijing, PR China
| | - Lanlan Ji
- Department of Rheumatology and Clinical Immunology
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology
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Kupfer S, Winklhofer S, Becker AS, Distler O, Chung CB, Alkadhi H, Finkenstaedt T. Gouty arthritis: Can we avoid unnecessary dual-energy CT examinations using prior radiographs? PLoS One 2018; 13:e0200473. [PMID: 29990381 PMCID: PMC6039044 DOI: 10.1371/journal.pone.0200473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 06/27/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The dual-energy CT (DECT) algorithm for urate detection is feasible only if hyperdense deposits are present. Based on our experience, around half of the performed DECT examinations show no such deposits and thus were useless for this indication. Our diagnostic accuracy study investigates whether conventional radiographs can serve as gatekeeper test prior to DECT for reliable exclusion of such radiopaque deposits. MATERIALS AND METHODS In this retrospective study, 77 clinically indicated DECT examinations of the hand (n = 29), foot (n = 36) and ankle (n = 12) of 55 patients (13 female, mean age 62±15 years) with suspected gouty arthritis were included. Two blinded readers independently evaluated DECT, gray-scale CT images (reference standard) and corresponding standardized radiographs for the presence/location of dense soft tissue deposits. RESULTS Interreader agreement for detection of soft tissue deposits with DECT and radiographs was excellent (DECT: both readers, κ = 1; radiographs: both readers, κ = 0.94). DECT showed soft tissue deposits in 54/77 DECT (70%) scans. 30/54 scans (56%) showed deposits on the corresponding radiographs, while in 24 scans (44%) no deposits were seen on radiographs. Test performance of radiographs for soft tissue deposit detection: sensitivity 56%, specificity 100%, PPV 100%, NPV 48.9%, and accuracy 69%. Low density of the deposits was the main reasons for false-negative radiographs (19 cases, 79%), followed by superimposition of deposits by osseous structures (5 cases, 21%). CONCLUSION Conventional radiographs of the hand, foot and ankle cannot serve as a gatekeeper test for reliable exclusion of radiopaque soft tissue deposits prior to DECT.
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Affiliation(s)
- Sivert Kupfer
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Winklhofer
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anton S. Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christine B. Chung
- Department of Radiology, University of California, San Diego, School of Medicine, United States of America
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiology, University of California, San Diego, School of Medicine, United States of America
- * E-mail:
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22
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Lee YH, Song GG. Diagnostic accuracy of dual-energy computed tomography in patients with gout: A meta-analysis. Semin Arthritis Rheum 2017; 47:95-101. [DOI: 10.1016/j.semarthrit.2017.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 12/21/2022]
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Mallinson PI, Coupal TM, McLaughlin PD, Nicolaou S, Munk PL, Ouellette HA. Dual-Energy CT for the Musculoskeletal System. Radiology 2017; 281:690-707. [PMID: 27870622 DOI: 10.1148/radiol.2016151109] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The principal advantages of dual-energy computed tomography (CT) over conventional CT in the musculoskeletal setting relate to the additional information provided regarding tissue composition, artifact reduction, and image optimization. This article discusses the manifestations of these in clinical practice-urate and bone marrow edema detection, metal artifact reduction, and tendon analysis, with potential in arthrography, bone densitometry, and metastases surveillance. The basic principles of dual-energy CT physics and scanner design will also be discussed. © RSNA, 2016.
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Affiliation(s)
- Paul I Mallinson
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Tyler M Coupal
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Patrick D McLaughlin
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Savvas Nicolaou
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Peter L Munk
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
| | - Hugue A Ouellette
- From the Department of Radiology, Vancouver General Hospital/University of British Columbia, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1M9
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New urate depositions on dual-energy computed tomography in gouty arthritis during urate-lowering therapy. Rheumatol Int 2017; 37:1365-1372. [PMID: 28447206 DOI: 10.1007/s00296-017-3724-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 04/18/2017] [Indexed: 12/27/2022]
Abstract
Reduction of urate depositions in the joints, on dual-energy computed tomography (DECT), in patients with gout during urate-lowering therapy (ULT) was demonstrated in previous studies. The aim of this study was to further investigate the changes in distribution of urate deposits during ULT. This randomized controlled trial enrolled 46 patients diagnosed with gout from Zhongshan Hospital, China, between October 2013 and June 2014. Epidemiological data, serum uric acid level, and arthritis attacks were recorded at monthly follow-up visits. DECT of bilateral feet and ankles was performed at baseline and after 6 months of ULT. Overall, 163 areas of urate deposition were found in the 46 patients; of these, 133/163 (81.6%) areas were associated with former arthritis attacks. On DECT at 6 months, the number of urate deposits decreased to 126, with 68 areas disappearing and 31 new deposits areas. The mean volume of urate deposits at baseline was 1.3 ± 3.8 cm3, decreasing to 0.6 ± 2.1 cm3 at the end of 6 months (P = 0.01), with 3/46 (6.5%) patients showing complete disappearance of urate deposits. New urate depositions were found in 21/46 (45.7%) patients, while urate depositions in some joints disappeared in some joints in 31/46 (67.4%) patients. High-sensitivity C-reactive protein was significantly lower in patients with new deposits (4.6 ± 9.3 vs. 7.1 ± 7.6 mg/dL; P = 0.01). There is dynamic redistribution of urate depositions in gout patients receiving ULT.
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Petsch C, Araujo E, Hueber A, Schett G, Manger B, Rech J. Gout mimicking rheumatoid arthritis. Semin Arthritis Rheum 2017; 46:e15. [DOI: 10.1016/j.semarthrit.2016.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/15/2016] [Indexed: 01/08/2023]
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Koh H, Low HC, Seet JE, Chua WY. Pancreatic gout and the role of multimodality imaging in its management. BMJ Case Rep 2016; 2016:bcr-2016-215449. [PMID: 27190122 DOI: 10.1136/bcr-2016-215449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Uric acid deposition in the pancreas is very rare and neither an endoscopic ultrasound (EUS) nor a contrast-enhanced CT image of this condition has ever been published. We describe a case of asymptomatic pancreatic gout that was detected incidentally on CT. Imaging features mimicked pancreatic neoplasm, warranting further evaluation with EUS-guided fine-needle aspiration. Samples revealed debris encrusted with monosodium urate crystals. Follow-up CT showed complete resolution with urate-lowering therapy. We aim to augment current knowledge on the imaging of pancreatic gout and discuss its management.
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Affiliation(s)
- Huiliang Koh
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - How Cheng Low
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| | - Ju Ee Seet
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Wynne Yuru Chua
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
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Getting the Most From Your Dual-Energy Scanner: Recognizing, Reducing, and Eliminating Artifacts. AJR Am J Roentgenol 2016; 206:119-28. [PMID: 26700343 DOI: 10.2214/ajr.14.13901] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Dual-energy CT (DECT) is an innovative imaging modality that allows superior detection of pulmonary embolism, enhanced detection of urate in gout, and improved assessment of metal prostheses when compared with conventional CT. CONCLUSION The primary aim of this review is to describe these DECT protocols and compare each to its respective diagnostic reference standards. Moreover, this review will describe how to recognize, reduce, and eliminate DECT artifacts, thereby maximizing its diagnostic capabilities.
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Metzger SC, Koehm M, Wichmann JL, Buettner S, Scholtz JE, Beeres M, Kerl JM, Albrecht MH, Hammerstingl R, Vogl TJ, Bauer RW. Dual-Energy CT in Patients with Suspected Gouty Arthritis: Effects on Treatment Regimen and Clinical Outcome. Acad Radiol 2016; 23:267-72. [PMID: 26749327 DOI: 10.1016/j.acra.2015.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/02/2015] [Accepted: 10/30/2015] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES This investigation aimed to evaluate the impact on treatment regimen and clinical outcome of dual-energy computed tomography (DECT) in patients with suspected gouty arthritis. MATERIALS AND METHODS We retrospectively analyzed electronic medical records (EMR) of 39 patients (36 male, 3 female; age range, 36-85 years) who underwent DECT of peripheral joints because of suspected gouty arthritis. We assessed the prior medical history, lab results, treatment regimen, and medications before and after DECT, and changes in subjective severity of symptoms as stated by patients in the EMR. The presence of monosodium urate (MSU) crystals in the index joint was verified with DECT. RESULTS Several patients had a prior diagnosis of gout (n = 9), hyperuricemia (n = 6), rheumatoid arthritis (n = 3), or psoriatic arthritis (n = 3). Elevated uric acid blood levels were detected in 32 patients (82%) before DECT. On DECT, MSU crystals were detected in 23 patients (59%). Of the 36 cases, the current treatment regimen was modified after DECT to gout-specific therapy in 22 cases and other rheumatic diseases were targeted in 14 cases. Several medications were prescribed more frequently based after DECT compared to before DECT imaging, including steroids (n = 20 vs. n = 12, respectively), colchicine (n = 13 vs. n = 4, respectively), and urate-lowering medication (n = 18 vs. n = 11, respectively). A subjective reduction of clinical symptoms during cumulative follow-up was reported by 34 patients (87.2%). CONCLUSIONS Both positive and negative findings of MSU crystals on DECT have a significant impact on the treatment regimen and clinical outcome of patients with suspected gouty arthritis and facilitate differentiation from other rheumatic diseases.
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Affiliation(s)
- Sarah C Metzger
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Michaela Koehm
- Department of Rheumatology, Clinic of the Goethe University, Frankfurt
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Stefan Buettner
- Department of Nephrology, Clinic of the Goethe University, Frankfurt
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Martin Beeres
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - J Matthias Kerl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Renate Hammerstingl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
| | - Ralf W Bauer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
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Turan A, Çeltikçi P, Tufan A, Öztürk MA. Basic radiological assessment of synovial diseases: a pictorial essay. Eur J Rheumatol 2016. [PMID: 28638696 DOI: 10.5152/eurjrheum.2015.0032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The synovium is a specialized tissue lining the synovial joints, bursae, and tendon sheaths of the body. It is affected by various localized or systemic disorders. Synovial diseases can be classified as inflammatory, infectious, degenerative, traumatic, hemorrhagic, and neoplastic. Damage in other intraarticular structures, particularly cartilages, generally occurs as a part of pathologic processes involving the synovium, leading to irreversible joint destruction. Imaging has an essential role in the early detection of synovial diseases prior to irreversible joint damage. Obtaining and understanding characteristic imaging findings of synovial diseases enables a proper diagnosis for early treatment. This article focuses on the recent literature that is related with the role of imaging in synovial disease.
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Affiliation(s)
- Aynur Turan
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital Ankara, Turkey
| | - Pınar Çeltikçi
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University Hospital, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Department of Internal Medicine, Division of Rheumatology, Gazi University Hospital, Ankara, Turkey
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Petsch C, Araujo EG, Englbrecht M, Bayat S, Cavallaro A, Hueber AJ, Lell M, Schett G, Manger B, Rech J. Prevalence of monosodium urate deposits in a population of rheumatoid arthritis patients with hyperuricemia. Semin Arthritis Rheum 2015; 45:663-8. [PMID: 26743072 DOI: 10.1016/j.semarthrit.2015.11.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 11/18/2015] [Accepted: 11/25/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate the prevalence of monosodium urate (MSU) crystal deposits, indicative for gout, in a population of rheumatoid arthritis (RA) patients with concomitant hyperuricemia and to analyze the clinical and disease-specific characteristics of RA patients who exhibit MSU crystal deposits. METHODS Overall, 100 consecutive patients with the diagnosis of RA and a serum urate level above 6mg/dl underwent dual energy computed tomography (DECT) of both feet and hands to search for MSU crystals in a prospective study between October 2011 and July 2013. Presence and extent of MSU crystal deposits on DECT was assessed by automated volume measurement. Demographic and disease-specific characteristics were recorded and included into two logistic regression models to test for the factors associated with MSU crystal deposits in RA. RESULTS Hyperuricemic RA patients were mostly male (55%), over 60 years of age (63 ± 11 years), had established disease (8.7 ± 10.5 years) and a mean disease activity score 28 (DAS 28) of 3.2. In total, 20 out of 100 patients displayed MSU crystal deposits in DECT. Interestingly, the majority (70%) of the RA patients positive for MSU crystal deposits were seronegative RA patients. Hence, every third seronegative RA patient had MSU crystal deposits. According to logistic regression model analysis, seronegative status correlated positively with presence of urate deposits (p = 0.019). CONCLUSIONS These data show that a considerable number of RA patients display periarticular MSU crystal deposits. Seronegative patients were shown to be predominantly affected with every third patient being positive for urate deposits.
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Affiliation(s)
- Christina Petsch
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Elizabeth G Araujo
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Sara Bayat
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Alexander Cavallaro
- Department of Radiology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Michael Lell
- Department of Radiology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Bernhard Manger
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany.
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Sun Y, Chen H, Zhang Z, Ma L, Zhou J, Zhou Y, Ding Y, Jin X, Jiang L. Dual-energy computed tomography for monitoring the effect of urate-lowering therapy in gouty arthritis. Int J Rheum Dis 2015. [PMID: 26217877 DOI: 10.1111/1756-185x.12634] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the relationships between changes in serum urate levels and dual-energy computed tomography (DE-CT) results during urate-lowering therapy (ULT) and to investigate the effects of treatment duration and drugs on changes in DE-CT results. METHODS Forty-four patients diagnosed with gout were enrolled in this investigation. DE-CT was conducted on the foot at baseline and the end of follow-up (6-24 months). Crystals were classified as: (i) L, number of large crystals with diameter ≥ 3 mm; (ii) S, number of small crystals with diameter < 3 mm; (iii) T, total number of crystals; and (iv) Vmax, volume of the maximal crystal. RESULTS Number of urate crystals (L, S as well as T) and Vmax decreased significantly through ULT. Significant decrease of urate crystal numbers and/or Vmax was observed in different follow-up groups, and the decrease in serum urate levels was positively related to the decrease of T (r = 0.43, P = 0.04) and Vmax (r = 0.63, P = 0.04). Moreover, analysis of covariance results demonstrated significant effects of treatment duration and serum urate levels on results of DE-CT. CONCLUSION Both urate crystal numbers and Vmax decreased significantly during ULT. Additionally, ULT duration and serum urate levels had significant effects on the decrease of Vmax and number of large crystals measured by DE-CT.
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Affiliation(s)
- Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhuojun Zhang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuejuan Jin
- Department of Statistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
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33
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Detection and Characterization of Crystal Suspensions Using Single-Source Dual-Energy Computed Tomography. Invest Radiol 2015; 50:255-60. [DOI: 10.1097/rli.0000000000000099] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kwon SW, Kim JH, Kang WC, Kim SJ, Kim HY, Kim HR, Lee SH. Carpal Tunnel Syndrome Associated with Tophaceous Deposition in Flexor Digitorum Tendons. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Se Woong Kwon
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Won Chan Kang
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Soo Jung Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ho Yeon Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Ogdie A, Taylor WJ, Weatherall M, Fransen J, Jansen TL, Neogi T, Schumacher HR, Dalbeth N. Imaging modalities for the classification of gout: systematic literature review and meta-analysis. Ann Rheum Dis 2014; 74:1868-74. [PMID: 24915980 DOI: 10.1136/annrheumdis-2014-205431] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although there has been major progress in gout imaging, no gout classification criteria currently include advanced imaging techniques. OBJECTIVE To examine the usefulness of imaging modalities in the classification of gout when compared to monosodium urate (MSU) crystal confirmation as the gold standard, in order to inform development of new gout classification criteria. METHODS We systematically reviewed the published literature concerning the diagnostic performance of plain film radiography, MRI, ultrasound (US), conventional CT and dual energy CT (DECT). Only studies with MSU crystal confirmation as the gold standard were included. When more than one study examined the same imaging feature, the data were pooled and summary test characteristics were calculated. RESULTS 11 studies (9 manuscripts and 2 meeting abstracts) satisfied the inclusion criteria. All were set in secondary care, with mean gout disease duration of at least 7 years. Three features were examined in more than one study: the double contour sign (DCS) on US, tophus on US, and MSU crystal deposition on DECT. The pooled (95% CI) sensitivity and specificity of US DCS were 0.83 (0.72 to 0.91) and 0.76 (0.68 to 0.83), respectively; of US tophus, were 0.65 (0.34 to 0.87) and 0.80 (0.38 to 0.96), respectively; and of DECT, were 0.87 (0.79 to 0.93) and 0.84 (0.75 to 0.90), respectively. CONCLUSIONS US and DECT show promise for gout classification but the few studies to date have mostly been in patients with longstanding, established disease. The contribution of imaging over clinical features for gout classification criteria requires further examination.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jaap Fransen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim L Jansen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tuhina Neogi
- Sections of Epidemiology and Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - H Ralph Schumacher
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
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The application of dual-energy computed tomography in the diagnosis of acute gouty arthritis. Clin Rheumatol 2014; 33:975-9. [PMID: 24744154 DOI: 10.1007/s10067-014-2606-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/30/2014] [Indexed: 12/27/2022]
Abstract
The aim of the study was to investigate the sensitivity and specificity of dual-energy computed tomography in the diagnosis of acute gouty arthritis, and the related risk factors for urate crystal deposition. One hundred ninety-one patients (143 with acute gouty arthritis and 48 with other arthritic conditions) were studied. All patients had acute arthritic attack in the recent 15 days and underwent dual-energy computed tomography (DECT) scan with the affected joints. The urate volume was calculated by DECT and the basic information of these patients was recorded at the same time. Uric acid crystals were identified with DECT in 140 of 143 (97.9 %) gout patients and 6 of 48 (12.5 %) of nongout patients, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of DECT in the diagnosis of acute gouty arthritis were 97.9, 87.5, 95.9, and 93.3 %, respectively. The urate volumes were ranged from 0.57 to 54,543.27 mm(3) with a mean volume of 1,787.81 ± 7,181.54 mm(3). Interestingly, urate volume was correlated with the disease duration, serum uric acid levels, the presence of tophi, and bone erosion. Two-year follow-up data was available in one patient with recurrent gouty arthritis, whose urate volume was gradually reduced in size by DECT detection after urate-lowering therapies. DECT showed high sensitivity and specificity for the identification of urate crystals and diagnosis of acute gout. The risk factors for uric acid deposition include the disease duration, serum uric acid levels, the presence of tophi, and bone erosion. DECT has an important role in the differential diagnosis of arthritis, and also could be served as a follow-up tool.
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Durcan L, Bolster F, Kavanagh EC, McCarthy GM. The structural consequences of calcium crystal deposition. Rheum Dis Clin North Am 2014; 40:311-28. [PMID: 24703349 DOI: 10.1016/j.rdc.2014.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Calcium pyrophosphate dihydrate and basic calcium phosphate (BCP) crystals are the most common calcium-containing crystals associated with rheumatic disease. Clinical manifestations of calcium crystal deposition include acute or chronic inflammatory and degenerative arthritides and certain forms of periarthritis. The intra-articular presence of BCP crystals correlates with the degree of radiographic degeneration. Calcium crystal deposition contributes directly to joint degeneration. Vascular calcification is caused by the deposition of calcium hydroxyapatite crystals in the arterial intima. These deposits may contribute to local inflammation and promote further calcification, thus aggravating the atherosclerotic process. Calcium crystal deposition results in substantial structural consequence in humans.
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Affiliation(s)
- Laura Durcan
- Division of Rheumatology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Ferdia Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Geraldine M McCarthy
- Division of Rheumatology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
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Sun Y, Ma L, Zhou Y, Chen H, Ding Y, Zhou J, Wei L, Zou H, Jiang L. Features of urate deposition in patients with gouty arthritis of the foot using dual-energy computed tomography. Int J Rheum Dis 2013; 18:560-7. [PMID: 24238356 DOI: 10.1111/1756-185x.12194] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate features of urate deposition in gout and the association between these features and attacks of gouty arthritis using dual-energy computed tomography (CT). METHODS Dual-energy CT scans of both feet were performed in 80 consecutive patients with gout and 22 with asymptomatic hyperuricemia. RESULTS Overall, 333 areas of urate deposition were found in patients with gout. The most commonly affected sites were the first metatarsophalangeal joint (MPJ; 57/333), the distal area of the first toe (59/333) and the calcaneal bone (61/333). For episodes of the first MPJ arthritis, urate deposits in the flexor pollicis longus muscle tendon (P = 0.02), as well as solitary and punctate depositions (P = 0.03 and 0.01, respectively) were positively related to the acute attacks. For episodes of arthritis around the ankle, deposits in the area, including the talus and inferior tibia, were associated with attacks of arthritis at the ankle (P = 0.02); additionally, deposits in the flexor tendon adjacent to the inferior tibia (P < 0.01) and a punctiform conformation were significantly associated with attacks of arthritis (P = 0.02). Logistic regression analysis showed that deposits around the first MPJ (OR = 3.38, 95% CI: 1.32, 8.17) or around the talus and inferior tibia (OR = 2.83, 95% CI: 1.11, 7.15) would increase the risk of an attack of arthritis. CONCLUSIONS Dual-energy CT imaging can be used to detect and analyze the features of urate deposition in patients with gout. Specific features of the deposits appeared to be associated with acute attacks of gouty arthritis.
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Affiliation(s)
- Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Wei
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hejian Zou
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
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Rajan A, Aati O, Kalluru R, Gamble GD, Horne A, Doyle AJ, McQueen FM, Dalbeth N. Lack of change in urate deposition by dual-energy computed tomography among clinically stable patients with long-standing tophaceous gout: a prospective longitudinal study. Arthritis Res Ther 2013; 15:R160. [PMID: 24286500 PMCID: PMC3978645 DOI: 10.1186/ar4343] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/07/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction Dual-energy computed tomography (DECT) has potential for monitoring urate deposition in patients with gout. The aim of this prospective longitudinal study was to analyse measurement error of DECT urate volume measurement in clinically stable patients with tophaceous gout. Methods Seventy-three patients with tophaceous gout on stable therapy attended study visits at baseline and twelve months. All patients had a comprehensive clinical assessment including serum urate testing and DECT scanning of both feet. Two readers analysed the DECT scans for the total urate volume in both feet. Analysis included inter-reader intraclass correlation coefficients (ICCs) and limits of agreement, and calculation of the smallest detectable change. Results Mean (standard deviation) serum urate concentration over the study period was 0.38 (0.09) mmol/L. Urate-lowering therapy was prescribed in 70 (96%) patients. The median (interquartile range) baseline DECT urate volume was 0.49 (0.16, 2.18) cm3, and change in DECT urate volume was -0.01 (-0.40, 0.28) cm3. Inter-reader ICCs were 1.00 for baseline DECT volumes and 0.93 for change values. Inter-reader bias (standard deviation) for baseline volumes was -0.18 (0.63) cm3 and for change was -0.10 (0.93) cm3. The smallest detectable change was 0.91 cm3. There were 47 (64%) patients with baseline DECT urate volumes <0.91 cm3. Higher serum urate concentrations were observed in patients with increased DECT urate volumes above the smallest detectable change (P = 0.006). However, a relationship between changes in DECT urate volumes and serum urate concentrations was not observed in the entire group. Conclusions In patients with tophaceous gout on stable conventional urate-lowering therapy the measurement error for DECT urate volume assessment is substantially greater than the median baseline DECT volume. Analysis of patients commencing or intensifying urate-lowering therapy should clarify the optimal use of DECT as a potential outcome measure in studies of chronic gout.
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