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Wang Q, Chen B, Zhang Z, Tang X, Li Y. Correlations of characteristics with tissue involvement in knee gouty arthritis: Magnetic resonance imaging analysis. Heliyon 2024; 10:e31888. [PMID: 38841465 PMCID: PMC11152737 DOI: 10.1016/j.heliyon.2024.e31888] [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: 03/04/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024] Open
Abstract
Objective This study investigates the MRI features of knee gouty arthritis (KGA), examines its relationship with the extent of tissue involvement, and assesses whether risk factors can predict KGA. Materials and methods Patients diagnosed with KGA underwent MRI examinations, and two independent observers retrospectively analyzed data from 44 patients (49 knees). These patients were divided into mild and severe groups based on tissue involvement observed during arthroscopy. MRI features were summarized, and the intraclass correlation coefficient evaluated interobserver reproducibility. Single-factor analysis compared clinical indicators and MRI features between groups, while Cramer's V coefficient assessed correlations. Multivariate logistic regression identified predictors of tissue involvement extent, and a ROC curve evaluated diagnostic performance. Results Among 49 knees, 18 had mild and 31 had severe tissue involvement. Key MRI features included ligament sketch-like changes, meniscal urate deposition, irregularly serrated cartilage changes, low-signal signs within joint effusion, synovial proliferation, Hoffa's fat pad synovitis, gouty tophi, bone erosion, and bone marrow edema. The interobserver reliability of the MRI features was good. Significant differences (P < 0.05) were observed between the groups for anterior cruciate ligament (ACL) sketch-like changes, Hoffa's fat pad synovitis, and gouty tophi. ACL sketch-like changes (r = 0.309), Hoffa's fat pad synovitis (r = 0.309), and gouty tophi (r = 0.408) were positively correlated with the extent of tissue involvement (P < 0.05). ACL sketch-like changes (OR = 9.019, 95 % CI: 1.364-61.880), Hoffa's fat pad synovitis (OR = 6.472, 95 % CI: 1.041-40.229), and gouty tophi (OR = 5.972, 95 % CI: 1.218-29.276) were identified as independent predictors of tissue involvement extent (P < 0.05). The area under the ROC curve was 0.862, with a sensitivity of 67.70 %, specificity of 94.40 %, and accuracy of 79.14 %. Conclusion This comprehensive analysis of MRI features identifies ligament sketch-like changes, meniscal urate deposition, and low-signal signs within joint effusion as characteristic MRI manifestations of KGA. Irregular cartilage changes are valuable for differential diagnosis in young and middle-aged patients. ACL sketch-like changes, Hoffa's fat pad synovitis, and gouty tophi correlate with tissue involvement severity and are critical in predicting and assessing the extent of tissue involvement in KGA.
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Affiliation(s)
- Qingshuai Wang
- Department of Sports Medicine Arthroscopy, Second Hospital, Jilin University, Changchun, 130041, China
| | - Bo Chen
- Department of Sports Medicine Arthroscopy, Second Hospital, Jilin University, Changchun, 130041, China
| | - Zhicheng Zhang
- Department of Sports Medicine Arthroscopy, Second Hospital, Jilin University, Changchun, 130041, China
| | - Xiongfeng Tang
- Department of Sports Medicine Arthroscopy, Second Hospital, Jilin University, Changchun, 130041, China
| | - Yingzhi Li
- Department of Sports Medicine Arthroscopy, Second Hospital, Jilin University, Changchun, 130041, China
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Sudoł-Szopińska I, Lanckoroński M, Teh J, Diekhoff T, Giraudo C, Chaudhary SR. Advanced Imaging of Gout and Other Inflammatory Diseases Around the Knee. Semin Musculoskelet Radiol 2024; 28:337-351. [PMID: 38768598 DOI: 10.1055/s-0044-1785471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The knee is one of the most commonly affected joints in the course of inflammatory arthropathies, such as crystal-induced and autoimmune inflammatory arthritis. The latter group includes systemic connective tissue diseases and spondyloarthropathies. The different pathogenesis of these entities results in their varied radiologic images. Some lead quickly to joint destruction, others only after many years, and in the remaining, destruction will not be a distinguishing radiologic feature.Radiography, ultrasonography, and magnetic resonance imaging have traditionally been the primary modalities in the diagnosis of noninflammatory and inflammatory arthropathies. In the case of crystallopathies, dual-energy computed tomography has been introduced. Hybrid techniques also offer new diagnostic opportunities. In this article, we discuss the pathologic findings and imaging correlations for crystallopathies and inflammatory diseases of the knee, with an emphasis on recent advances in their imaging diagnosis.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Michał Lanckoroński
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - DCTV, University of Padova, Padova, Italy
| | - Snehansh Roy Chaudhary
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Gessl I, Sakellariou G, Wildner B, Filippou G, Mandl P, D'Agostino MA, Navarro-Compán V. Systematic literature review to inform the EULAR recommendations for the use of imaging in crystal-induced arthropathies in clinical practice. Ann Rheum Dis 2024:ard-2023-225247. [PMID: 38702175 DOI: 10.1136/ard-2023-225247] [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: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To summarise current data regarding the use of imaging in crystal-induced arthropathies (CiAs) informing a European Alliance of Associations for Rheumatology task force. METHODS We performed four systematic searches in Embase, Medline and Central on imaging for diagnosis, monitoring, prediction of disease severity/treatment response, guiding procedures and patient education in gout, calcium pyrophosphate dihydrate deposition (CPPD) and basic calcium phosphate deposition (BCPD). Records were screened, manuscripts reviewed and data of the included studies extracted. The risk of bias was assessed by validated instruments. RESULTS For gout, 88 studies were included. Diagnostic studies reported good to excellent sensitivity and specificity of dual-energy CT (DECT) and ultrasound (US), high specificity and lower sensitivity for conventional radiographs (CR) and CT. Longitudinal studies demonstrated sensitivity to change with regard to crystal deposition by US and DECT and inflammation by US and structural progression by CR and CT. For CPPD, 50 studies were included. Diagnostic studies on CR and US showed high specificity and variable sensitivity. There was a single study on monitoring, while nine assessed the prediction in CPPD. For BCPD, 56 studies were included. There were two diagnostic studies, while monitoring by CR and US was assessed in 43 studies, showing a reduction in crystal deposition. A total of 12 studies with inconsistent results assessed the prediction of treatment response. The search on patient education retrieved two studies, suggesting a potential role of DECT. CONCLUSION This SLR confirmed a relevant and increasing role of imaging in the field of CiAs.
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Affiliation(s)
- Irina Gessl
- Division of Rheumatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Garifallia Sakellariou
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | | | - Georgios Filippou
- Rheumatology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Peter Mandl
- Division of Rheumatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
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Gao X, Gao H, Zhang L, Zhang L. Comparison of diagnostic efficacy of dual-energy CT and ultrasound in gouty arthritis. Int J Rheum Dis 2023; 26:1697-1703. [PMID: 37421186 DOI: 10.1111/1756-185x.14792] [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: 03/03/2023] [Revised: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To explore the performance and effect of dual-energy computed tomography (CT) and ultrasound in the diagnosis of gouty arthritis and to provide a reference for the clinical diagnosis of gouty arthritis. METHODS A retrospective analysis of 76 patients with gouty arthritis admitted to the hospital from June 2020 to June 2022 was conducted. Patients were diagnosed with gouty arthritis using ultrasound and dual-energy CT technology. The accuracy of diagnosis by different imaging techniques was analyzed along with the imaging findings of ultrasound and dual-energy CT. RESULTS Seventy-six patients, 60 men and 16 women, ranging in age from 20 to 77 years (mean age 50.8 ± 10.92 years), presented with uric acid levels of 254.1-720.05 μmol/L (mean 482.17 ± 105.06 μmol/L) and C-reactive protein levels ranging from 4.25 to 10.3 mg/L. The receiver operating characteristic curve showed that the area under the curve and specificity of serum uric acid were higher by dual-energy CT than those of ultrasound in the diagnosis of gouty arthritis. The dual-energy CT detection rate of tophi was significantly higher than the ultrasound detection rate (p < .05). For inflammatory effusion and synovial thickening, the ultrasound detection rates were significantly higher than the dual-energy CT detection rates (p < .05). Regarding soft-tissue edema, the detection rate of the two methods was not significantly different (p > .05). CONCLUSION Compared with ultrasound, dual-energy CT has increased accuracy in the diagnosis of gouty arthritis.
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Affiliation(s)
- Xiulin Gao
- Department of Clinical Medicine, Fenyang College of Shanxi Medical University, Fenyang, China
| | - Huanling Gao
- Department of Nursing, Fenyang College of Shanxi Medical University, Fenyang, China
| | - Liyun Zhang
- Department of Rheumatology, Shanxi Bethune Hospital, Taiyuan, China
| | - Liqing Zhang
- Department of Rheumatology, Shanxi Bethune Hospital, Taiyuan, China
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Zhong H, Wang M, Zhang H, Huang Z, Zou B, Zou G, Xie N, Liang Y, Zhu Y, Ma W. Gout of feet and ankles in different stages: The potentiality of a new semiquantitative DECT scoring system in monitoring urate deposition. Medicine (Baltimore) 2023; 102:e32722. [PMID: 36701727 PMCID: PMC9857379 DOI: 10.1097/md.0000000000032722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to investigate the diagnostic performance of a novel semi-quantitative dual-energy computed tomography (DECT) scoring system in monitoring urate deposition. This study included 287 patients with gout. All patients underwent ankle/foot DECT scans. DECT scores at different stages were compared and their diagnostic efficacies evaluated. Associations between DECT scores and clinical variables were evaluated. Gouts with positive DECT results in early, middle, and late stages were 78.5 %, 81.4 %, and 95.8 %, respectively (all P > .05). The total and ankle/midfoot DECT scores at different stages significantly increased with disease duration (all P < .05). DECT scores of 4 regions excluding the first metatarsophalangeal joint in early and middle stages were lower than those in late stage (all P < .05). DECT scores achieved excellent diagnostic performance for differentiating gout in early stage from middle and late stages (area under the curve, 0.923 and 0.949), with high sensitivity, specificity, positive predictive value, and negative predictive value (all > 85 %). Total DECT score was highly positively correlated with the volume of urate crystals (R = 0.873, P < .001). Disease duration, serum uric acid level, bone erosion, and Achilles tendon involvement significantly affected total DECT scores (all P < .01). In conclusion, longer disease duration, higher serum uric acid levels, bone erosion, and Achilles tendon involvement were closely associated with total DECT scores. DECT scoring system may be an invaluable tool for gout diagnosis owing to its high detection efficacy and a surrogate method to evaluate the amount of urate crystals and erosion of surrounding tissues.
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Affiliation(s)
- Huanhuan Zhong
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Minghua Wang
- Department of Pathology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Heng Zhang
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Zhitian Huang
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Baochang Zou
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Guannan Zou
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Nanai Xie
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Yiwen Liang
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Yuhui Zhu
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
| | - Wanling Ma
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong Province, China
- * Correspondence: Wanling Ma, Department of Radiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen, Aixin Road 53#, Shenzhen City, Guangdong Province 518172, China (e-mail: )
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Zheng WY, Zhan WF, Wang JY, Deng WM, Hung YK, Wang W, Jiang GH. Detailed analysis of the association between urate deposition and bone erosion in gout: a dual-energy computed tomography study. Front Endocrinol (Lausanne) 2023; 14:1167756. [PMID: 37143721 PMCID: PMC10153093 DOI: 10.3389/fendo.2023.1167756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/24/2023] [Indexed: 05/06/2023] Open
Abstract
Objective This study aimed to analyze the effect of urate deposition (UD) on bone erosion and examine the association between the volume of monosodium urate (MSU) crystals and an improved bone erosion score method, as measured in the metatarsophalangeal (MTP) joints of patients with gout. Materials and methods Fifty-six patients diagnosed with gout using the 2015 European League Against Rheumatism and American College of Rheumatology criteria were enrolled. MSU crystals volume at each MTP joint was measured using dual-energy computed tomography (DECT) images. The degree of bone erosion was evaluated with the modified Sharp/van der Heijde (SvdH) erosion scoring system based on CT images. Differences in clinical features between patients with (UD group) and without (non-UD group) UD were assessed, and the correlation between erosion scores and urate crystal volume was analyzed. Results The UD and non-UD groups comprised 30 and 26 patients, respectively. Among the 560 MTP joints assessed, 80 showed MSU crystal deposition, and 108 showed bone erosion. Bone erosion occurred in both groups but was significantly less severe in the non-UD group (p <0.001). Both groups had equivalent levels of serum uric acid (p=0.200). Symptom duration was significantly longer in the UD group (p=0.009). The UD group also had a higher rate of kidney stones (p=0.023). The volume of MSU crystals was strongly and positively associated with the degree of bone erosion (r=0.714, p <0.001). Conclusion This study found that patients with UD show significant increased bone erosion than those without UD. The volume of MSU crystals is associated with the improved SvdH erosion score based on CT images, regardless of serum uric acid level, demonstrating the potential of combining DECT and serum uric acid measurements in helping optimize the management of patients with gout.
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Affiliation(s)
- Wan-Yi Zheng
- Department of Medical Imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Wen-Feng Zhan
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | | | - Wei-Ming Deng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yu-Kai Hung
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wei Wang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Gui-Hua Jiang
- Department of Medical Imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
- *Correspondence: Gui-Hua Jiang,
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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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Pérez Ruiz F, Pérez Herrero N, Gantes Pedraza MÁ. Gout. What's up doc? Med Clin (Barc) 2022; 158:615-621. [PMID: 35177268 DOI: 10.1016/j.medcli.2022.01.002] [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: 10/14/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022]
Abstract
A considerable improvement in the knowledge of gout has taken place in the 2decades of the XXIth century. Definitions of disease, estate, and clinical situations, along with a new nomenclature, have been agreed. More importantly, the concept of gout as a "curable" or "controllable" disease has been settled. We know for the first time its prevalence in Spain. Factors associated to disease, the genetics that condition the predisposition to develop hyperuricemia and the structure and functions of the transportome complex that control the renal and intestinal handling of urate have been examined. Imaging techniques have come to support diagnosis. Different primary therapeutic targets have been defined depending on the burden of disease, and targets for secondary prevention considered. We know how to best prescribe available medications and prevent the risk of adverse events. Finally, we have understood the importance of adherence, education, and empower patients during treatment instead of blaming them.
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Affiliation(s)
- Fernando Pérez Ruiz
- Servicio de Reumatología, Hospital Universitario Cruces, Osakidetza, OSI Enkarterri-Eskerraldea-Cruces, Grupo de Investigación en Artritis, Instituto de Investigación Biocruces-Bizkaia, Departamento de Medicina, Facultad de Medicina y Enfermería, Universidad del País Vasco, Baracaldo, Vizcaya, España.
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