Abstract
ObjectivesTo 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.MethodsA 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.ResultsThe 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.ConclusionDECT (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.
Highlights
Gout is the most common form of inflammatory arthropathy resulting from monosodium urate (MSU) crystals deposition [1]
The presence of tophus, and bone erosion were associated with the urate crystal score system
The clinical utilization of dual-energy computer tomography (DECT) for gout diagnosis has dramatically increased over the past decade
Summary
Gout is the most common form of inflammatory arthropathy resulting from monosodium urate (MSU) crystals deposition [1]. Gout diagnosis is based on the identification of negative birefringent MSU crystals in the joint fluid or tophi by polarized microscopy. This method is seldom used in clinical practice owing to many limitations, such as invasiveness, lack of training, and microscopy unavailability [4]. The validity of DECT as a measure for gout diagnosis has been confirmed in many previously published literatures [6,7,8,9]. DECT has been incorporated into the 2015 American College of Rheumatology/European League Against Rheumatism gout classification criteria (ACR /EULAR 2015) based on reliable previously published data and its diagnostic accuracy [10]
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