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Dalbeth N, Botson J, Saag K, Kumar A, Padnick-Silver L, LaMoreaux B, Becce F. Monosodium urate crystal depletion and bone erosion remodeling during pegloticase treatment in patients with uncontrolled gout: Exploratory dual-energy computed tomography findings from MIRROR RCT. Joint Bone Spine 2024; 91:105715. [PMID: 38447697 DOI: 10.1016/j.jbspin.2024.105715] [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: 12/01/2023] [Revised: 01/19/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Monosodium-urate (MSU) crystal deposits can be visualized and quantified with dual-energy CT (DECT). Pegloticase lowers serum urate (SU) in uncontrolled gout patients, with methotrexate (MTX) co-therapy recommended to increase SU-lowering response rate and decrease infusion reaction risk. The literature on serial DECT-imaging during pegloticase+MTX co-therapy is sparse, with only 2 prior cases of rapid MSU deposition depletion with subsequent bone-erosion remodeling reported from a small open-label trial. Here, we report DECT findings during pegloticase treatment in a larger number of patients from a randomized controlled trial to confirm bone-erosion remodeling that follows MSU depletion with pegloticase. The influence of length-of-therapy is also explored. METHODS Patients received pegloticase (8mg every 2weeks)+MTX (15mg/week orally) or pegloticase+placebo (PBO) during the MIRROR RCT trial. A subset underwent DECT-imaging on Day1 (first pegloticase infusion) and at Weeks 14, 24, and 52. Patients with paired baseline-Week 52 images were included. Imaged regions with baseline MSU-crystal volume (VMSU)<0.5cm3 were excluded to minimize artifact contributions. VMSU and bone-erosion remodeling were assessed. RESULTS Eight patients (6 MTX, 2 PBO) were included. Included patients had received 52weeks (5 MTX), 42weeks (1 PBO), and 6weeks (1 MTX, 1 PBO) of pegloticase therapy. Patients who prematurely discontinued pegloticase maintained SU<6mg/dL on allopurinol (n=2)/febuxostat (n=1). At Week 52, VMSU had markedly decreased in both the pegloticase+MTX and pegloticase+PBO treatment groups, with faster depletion during pegloticase therapy. Bone-erosion remodeling was observed in 29/42 (69%) evaluated erosions: 29 (69%) size decrease, 4 (9.5%) recortication, 3 (7.1%) new bone formation. CONCLUSION Rapid VMSU depletion during pegloticase therapy was observed with concomitant bone remodeling within 1year. Following pegloticase discontinuation, VMSU reduction slowed or stopped even when SU was maintained<6mg/dL with oral ULT. CLINICAL TRIAL REGISTRATION NCT03994731.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, University of Auckland, M&HS Building 507, 28 Park Ave. Grafton, 1023 Auckland, New Zealand
| | - John Botson
- Orthopedic Physicians Alaska, 3801 Lake Otis Parkway, 99508 Anchorage, AK, United States
| | - Kenneth Saag
- University of Alabama at Birmingham, 2000 6th Ave. South, Floor 3, 35233 Birmingham, AL, United States
| | - Ada Kumar
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States
| | - Lissa Padnick-Silver
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States.
| | - Brian LaMoreaux
- Horizon Therapeutics plc (now Amgen, Inc.), 1 Horizon Way, 60015 Deerfield, IL, United States
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
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Ting YL, Lin HY, Huang TT, Hwang YS, Chui CS, Li MR, Wu TH. Quantitative Assessment of Lipiodol-Related Artifact Reduction for Dual-Energy Computed Tomography After Transcatheter Arterial Chemoembolization: A Phantom Study Evaluating the Use of Metal Artifact Reduction Algorithms. J Comput Assist Tomogr 2023; 47:704-712. [PMID: 37707399 DOI: 10.1097/rct.0000000000001477] [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: 05/21/2023]
Abstract
OBJECTIVE This study used metal artifact reduction (MAR) software to examine the computed tomography (CT) number of dual-energy CT (DECT) of hepatocellular carcinoma after transcatheter arterial chemoembolization. METHODS Hollow columnar acrylic phantoms were filled with lipiodol and inserts of 2 sizes (large and small) were used to simulate liver tumors on a Revolution GSI CT scanner. The CT numbers of a single test object were collected twice: once with and once without the MAR algorithm. Lipiodol beam-hardening artifacts were quantified by measuring CT numbers in a region of interest around the tumor-simulating insert. RESULTS The virtual monochromatic CT numbers of large and small tumors were closely related to energy. For small tumors, CT numbers increased with energy. For large tumors, CT numbers increased with energy at 1 cm from the margin but decreased with an increase in energy at 5 cm. Regardless of the size, distance, or location of the tumor, the CT numbers fluctuated more at low energy levels. CONCLUSIONS At 1 cm from the margin, the CT numbers with MAR were significantly different from those without MAR. Low-energy CT numbers with MAR were near reference values. Metal artifact reduction exhibited superior performance for small tumors. Tumor margin images are affected by artifacts caused by Lipiodol. However, with MAR, CT numbers can be effectively calibrated, thus enabling clinicians to more accurately evaluate hepatocellular carcinoma development and identify residual tumors and recurrent or metastatic lesions.
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Affiliation(s)
| | | | | | - Yi-Shuan Hwang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tu Cheng Hospital, New Taipei, Taiwan
| | | | | | - Tung-Hsin Wu
- From the Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University
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Yue NN, Xu HM, Xu J, Zhu MZ, Zhang Y, Tian CM, Nie YQ, Yao J, Liang YJ, Li DF, Wang LS. Application of Nanoparticles in the Diagnosis of Gastrointestinal Diseases: A Complete Future Perspective. Int J Nanomedicine 2023; 18:4143-4170. [PMID: 37525691 PMCID: PMC10387254 DOI: 10.2147/ijn.s413141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/02/2023] [Indexed: 08/02/2023] Open
Abstract
The diagnosis of gastrointestinal (GI) diseases currently relies primarily on invasive procedures like digestive endoscopy. However, these procedures can cause discomfort, respiratory issues, and bacterial infections in patients, both during and after the examination. In recent years, nanomedicine has emerged as a promising field, providing significant advancements in diagnostic techniques. Nanoprobes, in particular, offer distinct advantages, such as high specificity and sensitivity in detecting GI diseases. Integration of nanoprobes with advanced imaging techniques, such as nuclear magnetic resonance, optical fluorescence imaging, tomography, and optical correlation tomography, has significantly enhanced the detection capabilities for GI tumors and inflammatory bowel disease (IBD). This synergy enables early diagnosis and precise staging of GI disorders. Among the nanoparticles investigated for clinical applications, superparamagnetic iron oxide, quantum dots, single carbon nanotubes, and nanocages have emerged as extensively studied and utilized agents. This review aimed to provide insights into the potential applications of nanoparticles in modern imaging techniques, with a specific focus on their role in facilitating early and specific diagnosis of a range of GI disorders, including IBD and colorectal cancer (CRC). Additionally, we discussed the challenges associated with the implementation of nanotechnology-based GI diagnostics and explored future prospects for translation in this promising field.
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Affiliation(s)
- Ning-ning Yue
- Department of Gastroenterology, Shenzhen People’s Hospital (the Second Clinical Medical College, Jinan University), Shenzhen, Guangdong, People’s Republic of China
| | - Hao-ming Xu
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Jing Xu
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Min-zheng Zhu
- Department of Gastroenterology and Hepatology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, People’s Republic of China
| | - Yuan Zhang
- Department of Medical Administration, Huizhou Institute of Occupational Diseases Control and Prevention, Huizhou, Guangdong, People’s Republic of China
| | - Cheng-Mei Tian
- Department of Emergency, Shenzhen People’s Hospital (the Second Clinical Medical College, Jinan University), Shenzhen, Guangdong, People’s Republic of China
| | - Yu-qiang Nie
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China
| | - Jun Yao
- Department of Gastroenterology, Shenzhen People’s Hospital (the Second Clinical Medical College, Jinan University), Shenzhen, Guangdong, People’s Republic of China
| | - Yu-jie Liang
- Department of Child and Adolescent Psychiatry, Shenzhen Kangning Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - De-feng Li
- Department of Gastroenterology, Shenzhen People’s Hospital (the Second Clinical Medical College, Jinan University), Shenzhen, Guangdong, People’s Republic of China
| | - Li-sheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital (the Second Clinical Medical College, Jinan University), Shenzhen, Guangdong, People’s Republic of China
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Foti G, Longo C, D'Onofrio M, Natali S, Piovan G, Oliboni E, Iacono V, Guerriero M, Zorzi C. Dual-Energy CT for Detecting Painful Knee Prosthesis Loosening. Radiology 2023; 306:e211818. [PMID: 36255306 DOI: 10.1148/radiol.211818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Dual-energy CT (DECT) is an alternative to radiography and single-energy CT (SECT) for detecting prosthesis-related complications. Purpose To compare the diagnostic performance of DECT, SECT, and radiography for knee prosthesis loosening, with use of surgery or imaging follow-up reference standards. Materials and Methods In this prospective single-center study from December 2018 to June 2021, participants with unilateral painful knee prostheses underwent radiographic, SECT, and DECT imaging. Five blinded readers, four radiologists, and one orthopedic surgeon evaluated the images. Prosthesis loosening was diagnosed by a periprosthetic lucent zone greater than 2 mm. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of each method were determined and compared with use of a multireader multicase analysis. Results There were 92 study participants (mean age ± SD, 70 years ± 9.4; 67 women) evaluated. Tibial and femoral loosening were diagnosed in 47 and 24 participants, respectively. For the tibia, mean sensitivity and specificity for arthroplasty loosening were 88% and 91%, respectively, for DECT, 73% and 78% for SECT, and 68% and 81% for radiography. For the tibia, DECT demonstrated similar diagnostic performance (AUC, 0.90) to SECT (AUC: 0.90 vs AUC: 0.87, respectively; P = .13) but was superior to radiography (AUC: 0.90 vs AUC: 0.82; P = .002). Overall diagnostic performance of DECT (AUC, 0.87) for the femur was superior to both SECT and radiography (P < .001). Conclusion Dual-energy CT had generally better diagnostic performance in detecting loosening of tibial and femoral components after total knee arthroplasty compared with single-energy CT or radiography. Clinical trial registration no. 2942 © RSNA, 2022.
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Affiliation(s)
- Giovanni Foti
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
| | - Chiara Longo
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
| | - Mirko D'Onofrio
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
| | - Simone Natali
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
| | - Gianluca Piovan
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
| | - Eugenio Oliboni
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
| | - Venanzio Iacono
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
| | - Massimo Guerriero
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
| | - Claudio Zorzi
- From the Departments of Radiology (G.F., C.L., E.O.) and Orthopaedic Surgery (S.N., G.P., V.I., C.Z.), IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 10, 37024 Negrar, Italy; Department of Radiology, Verona University Hospital, Verona, Italy (M.D.); and Department of Computer Science, University of Verona, Verona, Italy (M.G.)
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Toprover M, Mechlin M, Fields T, Oh C, Becce F, Pillinger MH. Monosodium urate deposition in the lumbosacral spine of patients with gout compared with non-gout controls: A dual-energy CT study. Semin Arthritis Rheum 2022; 56:152064. [PMID: 35803060 DOI: 10.1016/j.semarthrit.2022.152064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gout is the most common cause of inflammatory arthritis in adults. Gout predominantly affects the peripheral joints, but an increasing number of published cases report gout affecting the spine. We used dual-energy CT (DECT) to assess the prevalence of monosodium urate (MSU) deposition in the spine of gout patients compared to controls, and to investigate whether gout or spinal MSU deposition is associated with low back pain. METHODS 25 controls and 50 gout subjects (non-tophaceous and tophaceous) were enrolled. Demographics, gout history, Aberdeen back pain score, serum urate (sU), ESR and CRP were ascertained. Subjects underwent DECT of the lumbosacral spine, which was analyzed using manufacturer's default post-processing algorithm for MSU deposition as well as a maximally-specific algorithm to exclude potential artifact. FINDINGS 72 subjects were analyzed (25 control, 47 gout). Gout subjects had greater BMI, serum creatinine, sU, CRP, and ESR versus controls. Using the default algorithm, MSU-coded volumes in the lumbosacral spines were significantly higher among the gout subjects vs controls (p = 0.018). 34% of gout subjects vs 4% of controls had spinal MSU-coded deposition (p = 0.0036). Applying the maximally-specific DECT post-processing algorithm, 18% of gout patients vs 0% of controls continued to demonstrate spinal MSU-coded deposition (p = 0.04). Non-tophaceous and tophaceous subjects did not differ in spinal MSU-coded deposition or sU. Gout patients had more back pain than controls. INTERPRETATION A significant subpopulation of gout patients have spinal MSU-coded lesions. Default and maximally-specific MSU post-processing algorithms yielded different absolute MSU-coded volumes, but similar patterns of results. Gout patients had more back pain than controls. Spinal MSU deposition in gout patients may have implications for clinical picture and treatment.
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Affiliation(s)
- Michael Toprover
- From the Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, USA; Rheumatology Section, NY Harbor Health Care System New York Campus, United States Department of Veterans Affairs, USA.
| | - Michael Mechlin
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, USA
| | - Theodore Fields
- Division of Rheumatology, The Hospital for Special Surgery, USA
| | - Cheongeun Oh
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, USA
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Michael H Pillinger
- From the Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, USA; Rheumatology Section, NY Harbor Health Care System New York Campus, United States Department of Veterans Affairs, USA
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Wen Y, Zhu W, Zhang X, Sun SK. Fabrication of gelatin Bi 2S 3 capsules as a highly sensitive X-ray contrast agent for gastrointestinal motility assessment in vivo. RSC Adv 2022; 12:13645-13652. [PMID: 35530383 PMCID: PMC9069310 DOI: 10.1039/d2ra00993e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022] Open
Abstract
Tiny BaSO4 rod-based X-ray imaging is the most frequently-used method for clinical diagnosis of gastrointestinal motility disorders. The BaSO4 rods usually have a small size to pass through the gastrointestinal tract smoothly, but suffer from unavoidably low sensitivity. Herein, we developed Bi2S3 capsules as a high-performance X-ray contrast agent for gastrointestinal motility assessment for the first time. The Bi2S3 capsules were synthesized by the encapsulation of commercial Bi2S3 powder into commercial gelatin capsules and subsequent coating of ultraviolet-curable resin. The prepared Bi2S3 capsules showed excellent biocompatibility in vitro and in vivo and superior X-ray attenuation ability due to the large atomic number and high K-edge value of Bi. The developed Bi2S3 capsules can serve as a small but highly sensitive X-ray contrast agent to quantitatively assess gastrointestinal motility in a vincristine-induced gastrointestinal motility disorder model in vivo by X-ray, CT and spectral CT imaging successfully, solving the intrinsic drawbacks of clinically used BaSO4.
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Affiliation(s)
- Ya Wen
- Department of Medical Imaging, Tianjin Medical University Tianjin 300203 China
| | - Wang Zhu
- Department of Radiographic Center, Wuhan Children's Hospital, Tongji Medical College of Huazhong University of Science and Technology Wuhan 430015 China
| | - Xuejun Zhang
- Department of Medical Imaging, Tianjin Medical University Tianjin 300203 China
| | - Shao-Kai Sun
- Department of Medical Imaging, Tianjin Medical University Tianjin 300203 China
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Dalbeth N, Becce F, Botson JK, Zhao L, Kumar A. Dual-energy CT assessment of rapid monosodium urate depletion and bone erosion remodelling during pegloticase plus methotrexate co-therapy. Rheumatology (Oxford) 2022; 61:4898-4904. [PMID: 35293984 PMCID: PMC9707016 DOI: 10.1093/rheumatology/keac173] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Pegloticase rapidly lowers serum urate in uncontrolled/refractory gout patients, with ≥1 tophus resolution in 70% of pegloticase responders and 28% of non-responders. Dual-energy computed tomography (DECT) non-invasively detects MSU deposition, including subclinical deposition, quantifies MSU volumes and depicts bone erosions. This report presents DECT findings in MIRROR open-label trial participants receiving pegloticase+MTX co-therapy. METHODS Serial DECT scans were obtained during pegloticase (8 mg biweekly infusions)+oral MTX (15 mg/week) co-therapy. Bilateral hand/wrist, elbow, foot/ankle and knee images were analysed with default post-processing settings. MSU volumes were quantified and bone erosions were identified and evaluated for remodelling (decreased size, sclerosis, new bone formation). DECT and physical examination findings were compared. RESULTS 2 patients underwent serial DECT. Patient 1 (44-year-old male) completed 52 weeks of pegloticase+MTX co-therapy (26 infusions). Baseline examination detected 4 tophus-affected joints while DECT identified 73 MSU-affected joints (total MSU volume: 128.76 cm3). At end-of-treatment, there were no clinically-affected joints and 4 joints with DECT-detected MSU deposition. MSU volume decreased by 99% and bone erosion remodelling was evident. Patient 2 (51-year-old male) had 10 weeks of therapy (5 infusions), discontinuing because of urate-lowering response loss. Baseline examination detected 7 tophus-affected joints while DECT identified 55 MSU-affected joints (total MSU volume: 59.20 cm3). At end-of-treatment, there were 5 clinically affected joints and 42 joints with DECT-detected MSU deposition. MSU volume decreased by 58% and bone erosion remodelling was evident. CONCLUSION DECT detected subclinical MSU deposition and quantified changes over time. Rapid tophus resolution and bone erosion remodelling occurred during pegloticase+MTX co-therapy. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03635957.
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Affiliation(s)
- Nicola Dalbeth
- Correspondence to: Nicola Dalbeth, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Waipapa Taumata Rau, Room 502-201D, 85 Park Road, Grafton, Auckland 1023, New Zealand. E-mail:
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Lin Zhao
- Medical Affairs, Horizon Therapeutics plc, Deerfield, IL, USA
| | - Ada Kumar
- Medical Affairs, Horizon Therapeutics plc, Deerfield, IL, USA
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Dubief B, Avril J, Pascart T, Schmitt M, Loffroy R, Maillefert JF, Ornetti P, Ramon A. Optimization of dual energy computed tomography post-processing to reduce lower limb artifacts in gout. Quant Imaging Med Surg 2022; 12:539-549. [PMID: 34993099 DOI: 10.21037/qims-21-321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/15/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND In gout, several types of dual-energy computed tomography (DECT) artifacts have been described (nail bed, skin, beam hardening, submillimeter and vascular artifacts), which can lead to overdiagnosis. The objective of this study was to determine the optimal DECT settings for post processing in order to reduce the frequency of some common artifacts in patients with suspected gout. METHODS Seventy-seven patients hospitalized for suspected gout (feet/ankles and/or knees) who received a DECT imaging were included (final diagnosis of 43 gout and 34 other rheumatic disorders). Different post-processing settings were evaluated using Syngovia software: nine settings (R1 to R9) were evaluated with a combination of different ratio (1.28, 1.36 and 1.55) and attenuation coefficient (120, 150, 170 HU). RESULTS Among the nine settings tested, the R2 setting (170 HU, ratio =1.28) significantly reduced the presence of knee and foot/ankle artifacts compared to the standard R1 setting (85% and 94% decrease in beam hardening and clumpy artifacts in the ankle and foot, respectively (P<0.001); a decrease of 71%, 60% and 88% respectively of meniscal beam hardening, beam hardening and submillimeter artifacts in the knee (P<0.001). Compared to standard settings, the use of R2 settings decreased sensitivity [0.79 (95% CI: 0.65, 0.88) versus 0.90 (95% CI: 0.78, 0.96)] and increased specificity [0.86 (95% CI: 0.71, 0.93) versus 0.63 (95% CI: 0.47, 0.77)] (P<0.001). Settings using an attenuation coefficient to 120 HU and/or a ratio to 1.55 were all associated with a significant increasing of artifacts, especially clumpy and beam hardening artifacts. CONCLUSIONS Applying a ratio of 1.28 and a minimum attenuation of 170 HU in DECT post-processing eliminates the majority of artifacts located in the lower limbs, particularly clumpy artifacts and beam hardening.
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Affiliation(s)
- Baptiste Dubief
- Rheumatology Department, Dijon-Bourgogne University Hospital, Dijon, France
| | - Julien Avril
- Diagnostic and Therapeutic Radiology Department, Dijon- Bourgogne University Hospital, Dijon, France
| | - Tristan Pascart
- Rheumatology Department, Lille Catholic Hospitals, University of Lille, Lomme, France.,EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, Lille, France
| | - Marie Schmitt
- Rheumatology Department, Dijon-Bourgogne University Hospital, Dijon, France
| | - Romaric Loffroy
- Diagnostic and Therapeutic Radiology Department, Dijon- Bourgogne University Hospital, Dijon, France
| | - Jean-Francis Maillefert
- Rheumatology Department, Dijon-Bourgogne University Hospital, Dijon, France.,INSERM UMR1093-CAPS, Université Bourgogne, UFR des Sciences du Sport, Dijon, France
| | - Paul Ornetti
- Rheumatology Department, Dijon-Bourgogne University Hospital, Dijon, France.,INSERM UMR1093-CAPS, Université Bourgogne, UFR des Sciences du Sport, Dijon, France.,CIC-P, Plurithematic Module, Technological Investigation Platform, Dijon-Burgundy University Hospital, Dijon, France
| | - André Ramon
- Rheumatology Department, Dijon-Bourgogne University Hospital, Dijon, France
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Shin DH, Song YS, Choi Y, Yoo WH, Kummel F, Park EH. Clumpy artifacts can be differentiated from tophi with DECT: comparison between gout-free and gouty patients. Br J Radiol 2022; 95:20210990. [PMID: 34767489 PMCID: PMC8722253 DOI: 10.1259/bjr.20210990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To accurately differentiate clumpy artifacts from tophi with foot and ankle DECT. METHODS AND MATERIALS In session 1, 108 clumpy artifacts from 35 patients and 130 tophi images from 25 patients were analyzed. Reviewers classified green pixelation according to anatomic location, shape (linear, stippled, angular, oval), and height and width ratio. In session 2, green pixelation confined to the tendon was evaluated (shape, height and width ratio, occupied area in the tendon, accompanied peritendinous green pixelation). RESULTS In session 1, while tophi were noted at various locations, almost all clumpy artifacts were located at the tendon (99%, p < 0.0001). Most clumpy artifacts were linear, stippled, and wide, while most tophi were angular and oval (p < 0.05). In session 2, the shape of green pixelation from clumpy artifacts and tophi was significantly different (p < 0.0001) and most clumpy artifacts occupied less than 50% of the tendon (p = 0.02), and most tophi were accompanied by peritendinous green pixelation (p < 0.0001). Univariant logistic regression showed that tophi were significantly correlated with peritendinous deposits, angular and oval shape, and more than 50% of the tendon (p < 0.05). CONCLUSION Clumpy artifacts can be differentiated from tophi in DECT. Clumpy artifacts typically are located in the tendon with a linear or stippled shape, wide, and less than 50% of a tendon's cross-section. Tophi, on the other hand, typically are oval, larger than 50% of the tendon's cross-section, and associated with adjacent peritendinous green pixelation. ADVANCES IN KNOWLEDGE Clumpy artifacts can be differentiated from tophi in image findings by their location and shape.
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Affiliation(s)
- Dong Han Shin
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - You Seon Song
- Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, Pusan, Republic of Korea
| | | | | | - Florian Kummel
- SHS DI CT M&S PCMM, Siemens Healthcare GmbH, Forchheim, Germany
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Weaver JS, Vina ER, Munk PL, Klauser AS, Elifritz JM, Taljanovic MS. Gouty Arthropathy: Review of Clinical Manifestations and Treatment, with Emphasis on Imaging. J Clin Med 2021; 11:jcm11010166. [PMID: 35011907 PMCID: PMC8745871 DOI: 10.3390/jcm11010166] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 12/22/2022] Open
Abstract
Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up of gouty arthropathy. The imaging findings of gouty arthropathy on radiography, ultrasonography, computed tomography, dual energy computed tomography, and magnetic resonance imaging are described to include findings of the early, acute and chronic phases of gout. These findings include early monosodium urate deposits, osseous erosions, and tophi, which may involve periarticular tissues, tendons, and bursae. Treatment of gout includes non-steroidal anti-inflammatories, colchicine, glucocorticoids, interleukin-1 inhibitors, xanthine oxidase inhibitors, uricosuric drugs, and recombinant uricase. Imaging is critical in monitoring response to therapy; clinical management can be modulated based on imaging findings. This review article describes the current standard of care in imaging and treatment of gouty arthropathy.
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Affiliation(s)
- Jennifer S. Weaver
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA;
- Correspondence:
| | - Ernest R. Vina
- Department of Medicine, University of Arizona Arthritis Center, Tucson, AZ 85724, USA;
| | - Peter L. Munk
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Department of Radiology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Andrea S. Klauser
- Radiology Department, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria;
| | - Jamie M. Elifritz
- Departments of Radiology and Pathology, University of New Mexico, Albuquerque, NM 87131, USA;
- New Mexico Office of the Medical Investigator, Albuquerque, NM 87131, USA
| | - Mihra S. Taljanovic
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA;
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85721, USA
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11
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The role of dual energy computed tomography in the differentiation of acute gout flares and acute calcium pyrophosphate crystal arthritis. Clin Rheumatol 2021; 41:223-233. [PMID: 34626261 PMCID: PMC8724058 DOI: 10.1007/s10067-021-05949-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/27/2022]
Abstract
Objectives To analyse the diagnostic impact of dual energy computed tomography (DECT) in acute gout flares and acute calcium pyrophosphate (CPP) crystal arthritis when compared to the gold standard of arthrocentesis with compensated polarised light microscopy. Microscopy results were also compared to musculoskeletal ultrasound (MUS), conventional radiographs, and the suspected clinical diagnosis (SCD). Methods Thirty-six patients with a suspected gout flare (n = 24) or acute CPP crystal arthritis (n = 11, n = 1 suffered from neither) who received a DECT and underwent arthrocentesis were included. Two independent readers assessed DECT images for signs of monosodium urate crystals or calcium pyrophosphate deposition. Results Sensitivity of DECT for gout was 63% (95% CI 0.41–0.81) with a specificity of 92% (0.41–0.81) while sensitivity and specificity for acute CPP arthritis were 55% (0.23–0.83) and 92% (0.74–0.99), respectively. MUS had the highest sensitivity of all imaging modalities with 92% (0.73–0.99) and a specificity of 83% (0.52–0.98) for gout, while sensitivity and specificity for acute CPP crystal arthritis were 91% (0.59–1.00) and 92% (0.74–0.99), respectively. Conclusion DECT is an adequate non-invasive diagnostic tool for acute gout flares but might have a lower sensitivity than described by previous studies. Both MUS and SCD had higher sensitivities than DECT for acute gout flares and acute CPP crystal arthritis. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-021-05949-4.
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12
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Singh JA, Budzik JF, Becce F, Pascart T. Dual-energy computed tomography vs ultrasound, alone or combined, for the diagnosis of gout: a prospective study of accuracy. Rheumatology (Oxford) 2021; 60:4861-4867. [PMID: 33410491 DOI: 10.1093/rheumatology/keaa923] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/06/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To examine the accuracy of dual-energy CT (DECT) vs ultrasound or their combination for the diagnosis of gout. METHODS Using prospectively collected data from an outpatient rheumatology clinic at a tertiary-care hospital, we examined the diagnostic accuracy of either modality alone or their combination, by anatomical site (feet/ankles and/or knees), for the diagnosis of gout. We used two standards: (i) demonstration of monosodium urate crystals in synovial fluid (gold), and (ii) modified (excluding DECT and ultrasound) 2015 ACR-EULAR gout classification criteria (silver). RESULTS Of the 147 patients who provided data, 48 (33%) had synovial fluid analysis performed (38 were monosodium urate-crystal positive) and mean symptom duration was 9.2 years. One hundred (68%) patients met the silver standard. Compared with the gold standard, diagnostic accuracy statistics for feet/ankles DECT, feet/ankles ultrasound, knees DECT and knees ultrasound were, respectively: sensitivity: 87%, 84%, 91% and 58%; specificity: 100%, 60%, 87% and 80%; positive predictive value: 100%, 89%, 97% and 92%; negative predictive value: 67%, 50%, 70% and 33%; area under the receiver operating characteristic curve: 0.93, 0.72, 0.89 and 0.66. Combining feet/ankles DECT with ultrasound or knees DECT with ultrasound led to a numerically higher sensitivity compared with DECT alone, but overall accuracy was lower. Similarly, combining imaging knees to feet/ankles also yielded a numerically higher sensitivity and negative predictive values compared with feet/ankles DECT alone, without differences in overall accuracy. Findings were replicated compared with the silver standard, but with lower numbers. CONCLUSIONS Feet/ankles or knees DECT alone had the best overall accuracy for gout diagnosis. The DECT-US combination or multiple joint imaging offered no additional increase in overall diagnostic accuracy.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham Veterans Affairs (VA) Medical Center.,Department of Medicine at School of Medicine.,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals, University of Lille, Lomme.,ULR 4490, Marrow Adiposity and Bone Laboratory (MABLab), University of Lille, Lille, France
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tristan Pascart
- ULR 4490, Marrow Adiposity and Bone Laboratory (MABLab), University of Lille, Lille, France.,Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France
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13
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Abdellatif W, Ding J, Khorshed D, Shojania K, Nicolaou S. Unravelling the mysteries of gout by multimodality imaging. Semin Arthritis Rheum 2021; 50:S17-S23. [PMID: 32620197 DOI: 10.1016/j.semarthrit.2020.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gout is a common inflammatory arthritis that manifests as an aggregate of variably symptomatic monosodium urate crystals (MSU) in the joints and surrounding tissues in addition to multisystem involvement such as genitourinary and cardiovascular systems. In recent decades, there has been a documented increase in the prevalence and incidence of gout. Risk factors for gout include obesity, dietary influences, hypertension, renal impairment, and diuretic use. A prompt diagnosis followed by uric acid lowering treatment prior to the onset of bone destruction is the goal in any suspected case of gout. Advanced imaging modalities, such as dual energy computed tomography (DECT) and ultrasonography (US), employed for the diagnosis of gout are each accompanied by advantages and disadvantages. Conventional radiography (CR), although useful in visualizing joint erosions and mineralization, is limited in its ability to diagnose gout flare. Although synovial fluid aspiration remains the gold standard for MSU crystal visualization, less-invasive imaging modalities are preferred to avoid potential complications. DECT and US in particular are useful in the diagnosis of gout. In this review, we will discuss the current state and role of imaging in the detection of gout.
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Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, Department of Emergency and Trauma Radiology, University of British Columbia/ Vancouver General Hospital, 899W 12th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Jeffrey Ding
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Kam Shojania
- Department of Rheumatology, University of British Columbia, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Department of Radiology, Department of Emergency and Trauma Radiology, University of British Columbia/ Vancouver General Hospital, 899W 12th Ave, Vancouver, BC V5Z 1M9, Canada.
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14
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Pascart T, Carpentier P, Choi HK, Norberciak L, Ducoulombier V, Luraschi H, Houvenagel E, Legrand J, Verclytte S, Becce F, Budzik JF. Identification and characterization of peripheral vascular color-coded DECT lesions in gout and non-gout patients: The VASCURATE study. Semin Arthritis Rheum 2021; 51:895-902. [PMID: 34198148 DOI: 10.1016/j.semarthrit.2021.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/17/2021] [Accepted: 06/15/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To characterize peripheral vascular plaques color-coded as monosodium urate (MSU) deposition by dual-energy computed tomography (DECT) and assess their association with the overall soft-tissue MSU crystal burden. METHODS Patients with suspected crystal arthropathies were prospectively included in the CRYSTALILLE inception cohort to undergo baseline knees and ankles/feet DECT scans; treatment-naive gout patients initiating treat-to-target urate-lowering therapy (ULT) underwent repeated DECT scans with concomitant serum urate level measurements at 6 and 12 months. We determined the prevalence of DECT-based vascular MSU-coded plaques in knee arteries, and assessed their association with the overall DECT volumes of soft-tissue MSU crystal deposition and coexistence of arterial calcifications. DECT attenuation parameters of vascular MSU-coded plaques were compared with dense calcified plaques, control vessels, control soft tissues, and tophi. RESULTS We investigated 126 gout patients and 26 controls; 17 ULT-naive gout patients were included in the follow-up study. The prevalence of DECT-based vascular MSU-coded plaques was comparable in gout patients (24.6%) and controls (23.1%; p=0.87). Vascular MSU-coded plaques were strongly associated with coexisting arterial calcifications (p<0.001), but not with soft-tissue MSU deposition. Characterization of vascular MSU-coded plaques revealed specific differences in DECT parameters compared with control vessels, control soft tissues, and tophi. During follow-up, vascular MSU-coded plaques remained stable despite effective ULT (p=0.64), which decreased both serum urate levels and soft-tissue MSU volumes (p<0.001). CONCLUSION Our findings suggest that DECT-based MSU-coded plaques in peripheral arteries are strongly associated with calcifications and may not reflect genuine MSU crystal deposition. Such findings should therefore not be a primary target when managing gout patients.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France.
| | - Paul Carpentier
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, USA
| | - Laurène Norberciak
- Department of Research, Biostatistics, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Hélène Luraschi
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Julie Legrand
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Sébastien Verclytte
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-François Budzik
- Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France
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15
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Shang J, Li XH, Lu SQ, Shang Y, Li LL, Liu B. Gout of feet and ankles in different disease durations: diagnostic value of single-source DECT and evaluation of urate deposition with a novel semi-quantitative DECT scoring system. Adv Rheumatol 2021; 61:36. [PMID: 34118994 DOI: 10.1186/s42358-021-00194-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/02/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To investigate the diagnostic performance of single-source dual-energy computed tomography (DECT) based on gemstone spectral imaging technology (including Discovery CT750HD and Revolution CT) in patients with suspected feet/ankles gouty arthritis, and evaluate the urate deposition with a novel semi-quantitative DECT scoring system. METHODS A total of 196 patients were consecutively included. Feet and ankles were evaluated in all patients by single-source DECT scan. The 2015 EULAR/ACR criteria were used as the reference for the diagnosis of gout. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of DECT for the diagnosis of gout in the early (≤1 year), middle (1-3 years), and late (> 3 years) disease durations were calculated. Besides, a novel semi-quantitative DECT scoring system was assessed for the measurement of urate deposition, and the correlation between the scores and the clinical and serological data were also evaluated. Moreover, the influences of artifacts on the diagnostic performance of DECT were also determined. RESULTS The sensitivity, specificity, and AUC of DECT in 196 patients were 38.10, 96.43%, and 0.673 in the early-stage group; 62.96, 100.00%, and 0.815 in the middle-stage group; and 77.55, 87.50%, and 0.825 in the late-stage group, respectively. The overall diagnostic accuracies in the AUC of DECT (Discovery CT750HD and Revolution CT) in the middle and late stages of gout were higher than that in the early stage of gout. Besides, the monosodium urate crystals were deposited on the first metatarsophalangeal joints and ankles/midfeet. Age, the presence of tophus, bone erosion, and disease duration considerably affected the total urate score. No statistical difference in the positive detection of nail artifact, skin artifact, vascular calcification, and noise artifact was found between the case and control groups. CONCLUSION DECT (Discovery CT750HD and Revolution CT) showed promising diagnostic accuracy for the detection of urate crystal deposition in gout but had limited diagnostic sensitivity for short-stage gout. Longer disease duration, the presence of tophus, and bone erosion were associated with the urate crystal score system. The artifacts do not remarkably affect the diagnostic performance of DECT in gout.
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Affiliation(s)
- Jin Shang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China
| | - Xiao-Hu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China
| | - Shu-Qin Lu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China
| | - Yi Shang
- Outpatient Department of The Second Central Division, The General Hospital of PLA, Beijing, 100853, China
| | - Lu-Lu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China
| | - Bin Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.
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16
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Parakh A, Lennartz S, An C, Rajiah P, Yeh BM, Simeone FJ, Sahani DV, Kambadakone AR. Dual-Energy CT Images: Pearls and Pitfalls. Radiographics 2021; 41:98-119. [PMID: 33411614 PMCID: PMC7853765 DOI: 10.1148/rg.2021200102] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 01/10/2023]
Abstract
Dual-energy CT (DECT) is a tremendous innovation in CT technology that allows creation of numerous imaging datasets by enabling discrete acquisitions at more than one energy level. The wide range of images generated from a single DECT acquisition provides several benefits such as improved lesion detection and characterization, superior determination of material composition, reduction in the dose of iodine, and more robust quantification. Technological advances and the proliferation of various processing methods have led to the availability of diverse vendor-based DECT approaches, each with a different acquisition and image reconstruction process. The images generated from various DECT scanners differ from those from conventional single-energy CT because of differences in their acquisition techniques, material decomposition methods, image reconstruction algorithms, and postprocessing methods. DECT images such as virtual monochromatic images, material density images, and virtual unenhanced images have different imaging appearances, texture features, and quantitative capabilities. This heterogeneity creates challenges in their routine interpretation and has certain associated pitfalls. Some artifacts such as residual iodine on virtual unenhanced images and an appearance of pseudopneumatosis in a gas-distended bowel loop on material-density iodine images are specific to DECT, while others such as pseudoenhancement seen on virtual monochromatic images are also observed at single-energy CT. Recognizing the potential pitfalls associated with DECT is necessary for appropriate and accurate interpretation of the results of this increasingly important imaging tool. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Anushri Parakh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Simon Lennartz
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Chansik An
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Benjamin M. Yeh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Frank J. Simeone
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Dushyant V. Sahani
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
| | - Avinash R. Kambadakone
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (A.P., S.L., F.J.S., A.R.K.); Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (C.A., B.M.Y.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.R.); Department of Radiology, University of Washington, Seattle, Wash (D.V.S.); and Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (S.L.)
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Gandikota G, Fakuda T, Finzel S. Computed tomography in rheumatology - From DECT to high-resolution peripheral quantitative CT. Best Pract Res Clin Rheumatol 2020; 34:101641. [PMID: 33281053 DOI: 10.1016/j.berh.2020.101641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this chapter, we discuss current updates and applications of Dual Energy Computed Tomography (DECT), iodine-DECT mapping, and high-resolution peripheral quantitative CT (HR-pQCT) in rheumatology. DECT provides a noninvasive diagnosis of gout and can help to differentiate gout from CPPD. Accuracy of DECT varies in various stages of gout. DECT needs specialized hardware, software, and skilled post-processing and interpretation. Sensitivity reduces significantly with deeper tissues such as hip and shoulder. Iodine map enables to delineate inflammatory lesions such as capsulitis and tenosynovitis by improving iodine contrast. Iodine quantification with an iodine map is a promising objective method to evaluate therapeutic effect of inflammatory arthritis. HR-pQCT allows for highly sensitive and specific measures of bone erosions and osteophytes in inflammatory joint diseases, documenting change over time, e.g. in cohorts undergoing immunosuppressive treatments. However, assessing the images requires trained readers, and (semi)-automated scripts to detect bone damage are still undergoing validation and further development.
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Affiliation(s)
- Girish Gandikota
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - Takeshi Fakuda
- Department of Radiology, The Jikei University School of Medicine, Japan
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Filippucci E, Reginato AM, Thiele RG. Imaging of crystalline arthropathy in 2020. Best Pract Res Clin Rheumatol 2020; 34:101595. [PMID: 33012644 DOI: 10.1016/j.berh.2020.101595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Crystal-related arthropathies are the result of crystal deposition in joint and periarticular soft tissues. Identification of urate crystals is mandatory to distinguish gout from other crystalline arthropathies, including calcium pyrophosphate dihydrate and basic calcium phosphate crystal deposition diseases. ACR/EULAR classification criteria for gout included dual-energy computed tomography and ultrasound with equal impact to the final score. Different diagnostic strengths of these imaging modalities depend on disease duration and scanned anatomic site. While ultrasound has been indicated as the first-choice imaging technique, especially in the early stages of the disease, dual-energy computed tomography has shown to be highly specific, allowing the detection of crystal deposits in anatomic sites not accessible by ultrasound, such as the spine. At the spinal level, MRI findings are usually nonspecific. Finally, there is preliminary evidence that at the knee, dual-energy computed tomography may discriminate calcium pyrophosphate dihydrate from basic calcium phosphate crystal deposits.
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Affiliation(s)
- Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy.
| | - Anthony M Reginato
- Division of Rheumatology, Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Ralf G Thiele
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester, Rochester, NY, USA.
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Giraudo C, Kainberger F, Boesen M, Trattnig S. Quantitative Imaging in Inflammatory Arthritis: Between Tradition and Innovation. Semin Musculoskelet Radiol 2020; 24:337-354. [PMID: 32992363 DOI: 10.1055/s-0040-1708823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radiologic imaging is crucial for diagnosing and monitoring rheumatic inflammatory diseases. Particularly the emerging approach of precision medicine has increased the interest in quantitative imaging. Extensive research has shown that ultrasound allows a quantification of direct signs such as bone erosions and synovial thickness. Dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography (CT) contribute to the quantitative assessment of secondary signs such as osteoporosis or lean mass loss. Magnetic resonance imaging (MRI), using different techniques and sequences, permits in-depth evaluations. For instance, the perfusion of the inflamed synovium can be quantified by dynamic contrast-enhanced imaging or diffusion-weighted imaging, and cartilage injury can be assessed by mapping (T1ρ, T2). Furthermore, the increased metabolic activity characterizing the inflammatory response can be reliably assessed by hybrid imaging (positron emission tomography [PET]/CT, PET/MRI). Finally, advances in intelligent systems are pushing forward quantitative imaging. Complex mathematical algorithms of lesions' segmentation and advanced pattern recognition are showing promising results.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine, DIMED, Radiology Institute, University of Padova, Padova, Italy
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High-Field MR Centre, Medical University of Vienna, Vienna, Austria
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Not All Green Is Tophi: The Importance of Optimizing Minimum Attenuation and Using a Tin Filter to Minimize Clumpy Artifacts on Foot and Ankle Dual-Energy CT. AJR Am J Roentgenol 2020; 214:1335-1342. [DOI: 10.2214/ajr.19.22222] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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McCollough CH, Boedeker K, Cody D, Duan X, Flohr T, Halliburton SS, Hsieh J, Layman RR, Pelc NJ. Principles and applications of multienergy CT: Report of AAPM Task Group 291. Med Phys 2020; 47:e881-e912. [DOI: 10.1002/mp.14157] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Kirsten Boedeker
- Canon (formerly Toshiba) Medical Systems Corporation 1440 Warnall Ave Los Angeles CA 90024 USA
| | - Dianna Cody
- University of Texas, M.D. Anderson Cancer Center 7163 Spanish Grant Galveston TX 77554‐7756 USA
| | - Xinhui Duan
- Southwestern Medical Center University of Texas 5323 Harry Hines Blvd Dallas TX 75390‐9071 USA
| | - Thomas Flohr
- Siemens Healthcare GmbH Siemensstr. 3 Forchheim BY 91031 Germany
| | | | - Jiang Hsieh
- GE Healthcare Technologies 3000 N. Grandview Blvd. W-1190 Waukesha WI 53188 USA
| | - Rick R. Layman
- University of Texas, M.D. Anderson Cancer Center 7163 Spanish Grant Galveston TX 77554‐7756 USA
| | - Norbert J. Pelc
- Stanford University 443 Via Ortega, Room 203 Stanford CA 94305‐4125 USA
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Thomas R, Qin L, Schmidlin EJ. The hazy humerus artifact – A potential cause for misdiagnosis on computed tomography of the chest. Clin Imaging 2020; 59:154-156. [DOI: 10.1016/j.clinimag.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/14/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022]
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23
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Svensson E, Aurell Y, Jacobsson LTH, Landgren A, Sigurdardottir V, Dehlin M. Dual energy CT findings in gout with rapid kilovoltage-switching source with gemstone scintillator detector. BMC Rheumatol 2020; 4:7. [PMID: 31989100 PMCID: PMC6966802 DOI: 10.1186/s41927-019-0104-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/30/2019] [Indexed: 12/27/2022] Open
Abstract
Background A definite diagnosis of gout requires demonstration of monosodium urate crystals in synovial fluid or in tophi, which in clinical practice today seldom is done. Dual energy CT (DECT) has repeatedly been shown to be able to detect monosodium urate crystals in tissues, hence being an alternative method to synovial fluid microscopy. The vast majority of these studies were performed with CT scanners with two X-ray tubes. In the present study we aim to investigate if and at what locations DECT with rapid kilovoltage-switching source with gemstone scintillator detector (GSI) can identify MSU crystals in patients with clinically diagnosed gout. We also performed a reliability study between two independent readings. Methods Patients with new or established gout who had been examined with DECT GSI scanning of the feet at Sahlgrenska University Hospital, Mölndal between 2015 and 2018 were identified. Their medical records were sought for gout disease characteristics using a structured protocol. Urate deposits in MTP1, MTP 2–5, ankle/midfoot joints and tendons were scored semiquantatively in both feet and presence of artifacts in nail and skin as well as beam hardening and noise were recorded. Two radiologists performed two combined readings and scoring of the images, thus consensus was reached over the scoring at each occasion (Espeland et al., BMC Med Imaging. 2013;13:4). The two readings were compared with kappa statistics. Results DECT GSI could identify urate deposits in the feet of all 55 participants with gout. Deposits were identified in the MTP-joints of all subjects but were also present in ankle/midfoot joints and tendons in 96 and 75% respectively. Deposition of urate was predicted by longer disease duration (Spearman’s Rho 0.64, p < .0001) and presence of tophi (p = 0.0005). Artifacts were common and mostly found in the nails (73%), a minority displayed skin artifacts (31%) while beam hardening and noise was rare. The agreement between the two readings was good (Κ = 0.66, 95% CI = 0.61–0.71). Conclusion The validity of DECT GSI in gout is supported by the identification of urate in all patients with clinical gout and the good correlations with clinical characteristics. The occurrence of artifacts was relatively low with expected locations.
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Affiliation(s)
- Elin Svensson
- 1Department of Radiology at Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ylva Aurell
- 1Department of Radiology at Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lennart T H Jacobsson
- 2Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden
| | - Anton Landgren
- 2Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden
| | - Valgerdur Sigurdardottir
- 2Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden.,3Center of Clinical Research (CKF) Dalarna, Uppsala University, Uppsala, Sweden
| | - Mats Dehlin
- 2Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Gothenburg, Sweden
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Development and validation of a quantitative method for estimation of the urate burden in patients with gouty arthritis using dual-energy computed tomography. Eur Radiol 2019; 30:404-412. [DOI: 10.1007/s00330-019-06350-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/15/2019] [Accepted: 06/28/2019] [Indexed: 12/27/2022]
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J, Coyfish M, Guillo S, Jansen T, Janssens H, Lioté F, Mallen CD, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell A, So AK, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2019; 79:31-38. [DOI: 10.1136/annrheumdis-2019-215315] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.
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Gout: Update on Dual-Energy Computed Tomography with Emphasis on Artifact Identification. Curr Rheumatol Rep 2018; 20:86. [DOI: 10.1007/s11926-018-0783-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Pascart T, Grandjean A, Capon B, Legrand J, Namane N, Ducoulombier V, Motte M, Vandecandelaere M, Luraschi H, Godart C, Houvenagel E, Norberciak L, Budzik JF. Monosodium urate burden assessed with dual-energy computed tomography predicts the risk of flares in gout: a 12-month observational study : MSU burden and risk of gout flare. Arthritis Res Ther 2018; 20:210. [PMID: 30223875 PMCID: PMC6142357 DOI: 10.1186/s13075-018-1714-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background Predicting the risk of flares in patients with gout is a challenge and the link between urate burden and the risk of gout flare is unclear. The objective of this study was to determine if the extent of monosodium urate (MSU) burden measured with dual-energy computed tomography (DECT) and ultrasonography (US) is predictive of the risk of gout flares. Methods This prospective observational study recruited patients with gout to undergo MSU burden assessment with DECT (volume of deposits) and US (double contour sign) scans of the knees and feet. Patients attended follow-up visits at 3, 6 and 12 months. Patients having presented with at least one flare at 6 months were compared to those who did not flare. Odds ratios (ORs) (95% confidence interval) for the risk of flare were calculated. Results Overall, 64/78 patients included attended at least one follow-up visit. In bivariate analysis, the number of joints with the double contour sign was not associated with the risk of flare (p = 0.67). Multivariate analysis retained a unique variable: DECT MSU volume of the feet. For each 1 cm3 increase in DECT MSU volume in foot deposits, the risk of flare increased 2.03-fold during the first 6 months after initial assessment (OR 2.03 (1.15–4.38)). The threshold volume best discriminating patients with and without flare was 0.81 cm3 (specificity 61%, sensitivity 77%). Conclusions This is the first study showing that the extent of MSU burden measured with DECT but not US is predictive of the risk of flares. Electronic supplementary material The online version of this article (10.1186/s13075-018-1714-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France. .,EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, 59000, Lille, France. .,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France.
| | - Agathe Grandjean
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Benoist Capon
- Department of Radiology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Julie Legrand
- Department of Radiology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Nasser Namane
- Department of Radiology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Vincent Ducoulombier
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Marguerite Motte
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Marie Vandecandelaere
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Hélène Luraschi
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Catherine Godart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Eric Houvenagel
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Laurène Norberciak
- Department of Medical Research, Biostatistics, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
| | - Jean-François Budzik
- Department of Radiology, Lille Catholic Hospitals, University of Lille, 59160, Lomme, France.,EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, 59000, Lille, France.,Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France
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Jeon JY, Lee SW, Jeong YM, Baek HJ. The effect of tube voltage combination on image artefact and radiation dose in dual-source dual-energy CT: comparison between conventional 80/140 kV and 80/150 kV plus tin filter for gout protocol. Eur Radiol 2018; 29:1248-1257. [PMID: 29987420 DOI: 10.1007/s00330-018-5622-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In dual-source CT, dual-energy (DE) performance is affected by various X-ray tube voltage combinations with and without tin filter (Sn). The purpose of this study was to assess the utility of the 80/150 Sn kV voltage combination in terms of image artefact and radiation dose for DECT gout protocol, compared with the conventional 80/140 kV. METHODS Seventy-four patients with suspected gout who underwent dual-source DECT examinations scanned at 80/140 kV (n = 37) and at 80/150 Sn kV (n = 37) were included. Patients' age, sex, and serum uric acid levels were matched between the two groups. The types and incidence of image artefacts and radiation dose were evaluated. RESULTS The 80/150 Sn kV group had significantly fewer patients with artefacts, compared to the 80/140 kV group [11 (30 %) of 37 vs 35 (94.6 %) of 37, p < 0.001]. Except for the motion artefact, the rest of the artefacts-skin, nail bed, submillimetre, motion, vascular, beam-hardening, clumpy artefact along tendon-were significantly less observed in the 80/150 Sn kV acquisitions. The dose-length product (DLP) and effective dose were significantly lower for the 80/150 Sn kV acquisitions compared with the 8s0/140 kV scans (DLP: 104.46 ± 10.66 mGy·cm vs 344.70 ± 56.39 mGy·cm, p < 0.001; effective dose: 1.04 ± 0.11 mSv vs 3.45 ± 0.56 mSv, p < 0.001). CONCLUSIONS The 80/150 Sn kV voltage combination in dual-source DECT system could be used as one of the artefact reduction methods while reducing radiation dose for gout protocol when compared to the conventional 80/140 kV. KEY POINTS • DECT has emerged as the leading modality for non-invasive diagnosis of gout. • Various X-ray tube voltage combinations are now feasible in dual-source DECT. • The 80/150 Sn kV acquisition could facilitate artefact reduction in gout protocol.
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Affiliation(s)
- Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
| | - Sheen-Woo Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero, 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
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Su KH, Kuo JW, Jordan DW, Van Hedent S, Klahr P, Wei Z, Al Helo R, Liang F, Qian P, Pereira GC, Rassouli N, Gilkeson RC, Traughber BJ, Cheng CW, Muzic RF. Machine learning-based dual-energy CT parametric mapping. Phys Med Biol 2018; 63:125001. [PMID: 29787382 DOI: 10.1088/1361-6560/aac711] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim is to develop and evaluate machine learning methods for generating quantitative parametric maps of effective atomic number (Zeff), relative electron density (ρ e), mean excitation energy (I x ), and relative stopping power (RSP) from clinical dual-energy CT data. The maps could be used for material identification and radiation dose calculation. Machine learning methods of historical centroid (HC), random forest (RF), and artificial neural networks (ANN) were used to learn the relationship between dual-energy CT input data and ideal output parametric maps calculated for phantoms from the known compositions of 13 tissue substitutes. After training and model selection steps, the machine learning predictors were used to generate parametric maps from independent phantom and patient input data. Precision and accuracy were evaluated using the ideal maps. This process was repeated for a range of exposure doses, and performance was compared to that of the clinically-used dual-energy, physics-based method which served as the reference. The machine learning methods generated more accurate and precise parametric maps than those obtained using the reference method. Their performance advantage was particularly evident when using data from the lowest exposure, one-fifth of a typical clinical abdomen CT acquisition. The RF method achieved the greatest accuracy. In comparison, the ANN method was only 1% less accurate but had much better computational efficiency than RF, being able to produce parametric maps in 15 s. Machine learning methods outperformed the reference method in terms of accuracy and noise tolerance when generating parametric maps, encouraging further exploration of the techniques. Among the methods we evaluated, ANN is the most suitable for clinical use due to its combination of accuracy, excellent low-noise performance, and computational efficiency.
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Affiliation(s)
- Kuan-Hao Su
- Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH, United States of America. Department of Radiology, Case Western Reserve University, Cleveland, OH, United States of America
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Abstract
OBJECTIVE The aim of this article is to provide an overview of newer techniques and postprocessing tools that improve the potential impact of CT in forensic situations. CONCLUSION CT has become a standard tool in medicolegal practice. Postmortem CT is an essential aid to the pathologist during autopsies. Advances in technology and software are constantly leading to advances in its performance.
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Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, Fox MG, Kransdorf MJ, Mintz DN, Shah NA, Small KM, Smith SE, Tynus KM, Weissman BN. ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty. J Am Coll Radiol 2018; 14:S421-S448. [PMID: 29101982 DOI: 10.1016/j.jacr.2017.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Mary G Hochman
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yulia V Melenevsky
- Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Darlene F Metter
- Co-author, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Kathy M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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Gascho D, Thali MJ, Niemann T. Post-mortem computed tomography: Technical principles and recommended parameter settings for high-resolution imaging. MEDICINE, SCIENCE, AND THE LAW 2018; 58:70-82. [PMID: 29310502 DOI: 10.1177/0025802417747167] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Post-mortem computed tomography (PMCT) has become a standard procedure in many forensic institutes worldwide. However, the standard scan protocols offered by vendors are optimised for clinical radiology and its main considerations regarding computed tomography (CT), namely, radiation exposure and motion artefacts. Thus, these protocols aim at low-dose imaging and fast imaging techniques. However, these considerations are negligible in post-mortem imaging, which allows for significantly increased image quality. Therefore, the parameters have to be adjusted to achieve the best image quality. Several parameters affect the image quality differently and have to be weighed against each other to achieve the best image quality for different diagnostic interests. There are two main groups of parameters that are adjustable by the user: acquisition parameters and reconstruction parameters. Acquisition parameters have to be selected prior to scanning and affect the raw data composition. In contrast, reconstruction parameters affect the calculation of the slice stacks from the raw data. This article describes the CT principles from acquiring image data to post-processing and provides an overview of the significant parameters for increasing the image quality in PMCT. Based on the CT principles, the effects of these parameters on the contrast, noise, resolution and frequently occurring artefacts are described. This article provides a guide for the performance of PMCT in morgues, clinical facilities or private practices.
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Affiliation(s)
- Dominic Gascho
- 1 Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Michael J Thali
- 1 Department of Forensic Medicine and Imaging, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Tilo Niemann
- 2 Department of Radiology, Cantonal Hospital Baden, Switzerland
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Quantitative Comparison of Virtual Monochromatic Images of Dual Energy Computed Tomography Systems. J Comput Assist Tomogr 2018; 42:648-654. [DOI: 10.1097/rct.0000000000000726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sakaida H, Usui S, Matsuda Y, Masuda S, Takeuchi K. Sonographic diagnosis of acute mastoiditis and subsequent retroauricular abscess in a pediatric cochlear implant recipient: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:515-519. [PMID: 28369924 DOI: 10.1002/jcu.22442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/15/2016] [Accepted: 12/04/2016] [Indexed: 06/07/2023]
Abstract
When acute mastoiditis occurs in cochlear implant recipients, it can progress to subsequent retroauricular abscess due to the absence of the external mastoid cortex resulting from mastoidectomy performed for cochlear implantation. The management goal is to control infection while preserving the implanted device. A 2-year-old boy with cochlear implants developed acute mastoiditis and a subsequent retroauricular abscess. The patient underwent a surgical intervention based on the diagnosis made utilizing gray-scale and power Doppler sonography. This case illustrates the diagnostic usefulness of sonography in this rare situation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:515-519, 2017.
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Affiliation(s)
- Hiroshi Sakaida
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Satoko Usui
- Department of Otorhinolaryngology, National Mie Hospital, Tsu, Mie, Japan
| | - Yasunori Matsuda
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Sawako Masuda
- Department of Otorhinolaryngology, National Mie Hospital, Tsu, Mie, Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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35
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Norman N, Dimmock M, Lee K, Graham J, Bassed R. The applicability of Dual-Energy Computed Tomography (DECT) in forensic odontology – A review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jofri.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Madhuripan N, Mehta P, Smolinski SE, Njuguna N. Computed Tomography Angiography of the Extremities in Emergencies. Semin Ultrasound CT MR 2017; 38:357-369. [DOI: 10.1053/j.sult.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Goo HW, Goo JM. Dual-Energy CT: New Horizon in Medical Imaging. Korean J Radiol 2017; 18:555-569. [PMID: 28670151 PMCID: PMC5447632 DOI: 10.3348/kjr.2017.18.4.555] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/23/2017] [Indexed: 12/18/2022] Open
Abstract
Dual-energy CT has remained underutilized over the past decade probably due to a cumbersome workflow issue and current technical limitations. Clinical radiologists should be made aware of the potential clinical benefits of dual-energy CT over single-energy CT. To accomplish this aim, the basic principle, current acquisition methods with advantages and disadvantages, and various material-specific imaging methods as clinical applications of dual-energy CT should be addressed in detail. Current dual-energy CT acquisition methods include dual tubes with or without beam filtration, rapid voltage switching, dual-layer detector, split filter technique, and sequential scanning. Dual-energy material-specific imaging methods include virtual monoenergetic or monochromatic imaging, effective atomic number map, virtual non-contrast or unenhanced imaging, virtual non-calcium imaging, iodine map, inhaled xenon map, uric acid imaging, automatic bone removal, and lung vessels analysis. In this review, we focus on dual-energy CT imaging including related issues of radiation exposure to patients, scanning and post-processing options, and potential clinical benefits mainly to improve the understanding of clinical radiologists and thus, expand the clinical use of dual-energy CT; in addition, we briefly describe the current technical limitations of dual-energy CT and the current developments of photon-counting detector.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
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38
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Yeh BM, FitzGerald PF, Edic PM, Lambert JW, Colborn RE, Marino ME, Evans PM, Roberts JC, Wang ZJ, Wong MJ, Bonitatibus PJ. Opportunities for new CT contrast agents to maximize the diagnostic potential of emerging spectral CT technologies. Adv Drug Deliv Rev 2017; 113:201-222. [PMID: 27620496 PMCID: PMC5344792 DOI: 10.1016/j.addr.2016.09.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/15/2022]
Abstract
The introduction of spectral CT imaging in the form of fast clinical dual-energy CT enabled contrast material to be differentiated from other radiodense materials, improved lesion detection in contrast-enhanced scans, and changed the way that existing iodine and barium contrast materials are used in clinical practice. More profoundly, spectral CT can differentiate between individual contrast materials that have different reporter elements such that high-resolution CT imaging of multiple contrast agents can be obtained in a single pass of the CT scanner. These spectral CT capabilities would be even more impactful with the development of contrast materials designed to complement the existing clinical iodine- and barium-based agents. New biocompatible high-atomic number contrast materials with different biodistribution and X-ray attenuation properties than existing agents will expand the diagnostic power of spectral CT imaging without penalties in radiation dose or scan time.
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Affiliation(s)
- Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States.
| | - Paul F FitzGerald
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Peter M Edic
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Jack W Lambert
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Robert E Colborn
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Michael E Marino
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Paul M Evans
- GE Healthcare Life Sciences, The Grove Centre, White Lion Road, Amersham, Buckinghamshire HP7 9LL, United Kingdom
| | - Jeannette C Roberts
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Margaret J Wong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Peter J Bonitatibus
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
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Chou H, Chin TY, Peh WCG. Dual-energy CT in gout - A review of current concepts and applications. J Med Radiat Sci 2017; 64:41-51. [PMID: 28238226 PMCID: PMC5355369 DOI: 10.1002/jmrs.223] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/13/2017] [Indexed: 12/11/2022] Open
Abstract
Dual‐energy computed tomography (DECT) is a relatively recent development in the imaging of gouty arthritis. Its availability and usage have become increasingly widespread in recent years. DECT is a non‐invasive method for the visualisation, characterisation and quantification of monosodium urate crystal deposits which aids the clinician in the early diagnosis, treatment and follow‐up of this condition. This article aims to give an up to date review and summary of existing literature on the role and accuracy of DECT in the imaging of gout. Techniques in image acquisition, processing and interpretation will be discussed along with pitfalls, artefacts and clinical applications.
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Affiliation(s)
- Hong Chou
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Alexandra Health, Singapore, Singapore
| | - Teck Yew Chin
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Alexandra Health, Singapore, Singapore
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Alexandra Health, Singapore, Singapore
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40
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Jayakumar D, Sehra ST, Anand S, Stallings GW, Danve A. Role of Dual Energy Computed Tomography Imaging in the Diagnosis of Gout. Cureus 2017; 9:e985. [PMID: 28229032 PMCID: PMC5318147 DOI: 10.7759/cureus.985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gout is a well-known inflammatory arthritis and affects four percent of the United States population. It results from the deposition of uric acid crystals in joints, tendons, bursae, and other surrounding tissues. Prevalence of gout has increased in the recent decade. Gout is usually seen in conjunction with other chronic comorbid conditions like cardiac disease, metabolic syndrome, and renal disease. The diagnosis of this inflammatory arthritis is confirmed by visualization of monosodium urate (MSU) crystals in the synovial fluid. Though synovial fluid aspiration is the standard of care, it is often deferred because of inaccessibility of small joints, patient assessment during intercritical period, or procedural inexperience in a primary care office. Dual energy computed tomography (DECT) is a relatively new imaging modality which shows great promise in the diagnosis of gout. It is a good noninvasive alternative to synovial fluid aspiration. DECT is increasingly useful in diagnosing cases of gout where synovial fluid fails to demonstrate monosodium urate crystals. In this article, we will review the mechanism, types, advantages, and disadvantages of DECT.
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Affiliation(s)
| | | | - Suneesh Anand
- Covenant Medical Center, Central Michigan University
| | | | - Abhijeet Danve
- Yale New Haven Hospital, Yale University School of Medicine
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41
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Tilve-Gómez A, Rodríguez-Fernández P, Trillo-Fandiño L, Plasencia-Martínez JM. Imaging techniques used in the diagnostic workup of acute venous thromboembolic disease. RADIOLOGIA 2016; 59:329-342. [PMID: 27986265 DOI: 10.1016/j.rx.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/09/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
Early diagnosis is one of the most important factors affecting the prognosis of pulmonary embolism (PE); however, the clinical presentation of PE is often very unspecific and it can simulate other diseases. For these reasons, imaging tests, especially computed tomography angiography (CTA) of the pulmonary arteries, have become the keystone in the diagnostic workup of PE. The wide availability and high diagnostic performance of pulmonary CTA has led to an increase in the number of examinations done and a consequent increase in the population's exposure to radiation and iodinated contrast material. Thus, other techniques such as scintigraphy and venous ultrasonography of the lower limbs, although less accurate, continue to be used in certain circumstances, and optimized protocols have been developed for CTA to reduce the dose of radiation (by decreasing the kilovoltage) and the dose of contrast agents. We describe the technical characteristics and interpretation of the findings for each imaging technique used to diagnose PE and discuss their advantages and limitations; this knowledge will help the best technique to be chosen for each case. Finally, we comment on some data about the increased use of CTA, its clinical repercussions, its "overuse", and doubts about its cost-effectiveness.
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Affiliation(s)
- A Tilve-Gómez
- Servicio de Radiodiagnóstico, IISGS, XXIV, Hospital Álvaro Cunqueiro, Vigo (Pontevedra), España.
| | - P Rodríguez-Fernández
- Servicio de Radiodiagnóstico, IISGS, XXIV, Hospital Álvaro Cunqueiro, Vigo (Pontevedra), España
| | - L Trillo-Fandiño
- Servicio de Radiodiagnóstico, IISGS, XXIV, Hospital Álvaro Cunqueiro, Vigo (Pontevedra), España
| | - J M Plasencia-Martínez
- Servicio de Radiodiagnóstico, Hospital General Universitario José María Morales Meseguer, Murcia, España
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