Abstract
ObjectivesThe purpose of this study was to compare findings of ultrasound (US) with dual-energy CT (DECT) in patients presenting with suspected gouty hand and wrist arthritis.MethodsThis prospective study included 180 patients (136 men and 44 women, age range, 31– 94 years; mean age, 65.9 years) with an initial clinical diagnosis of acute gouty arthritis who underwent DECT and US examination. Intra- and extra-articular findings of each modality were tabulated and calculated with DECT as gold standard.ResultsThe final diagnosis of gout was positive in 97/180 patients (53.9%) by DECT, an alternative diagnosis confirmed in 83 patients. US showed a sensitivity of 70.1% (extra-articular: 42.5%, p < 0.0001; intra-articular: 80.3%, p = 0.14) and specificity of 51%. The double contour sign (DCS) was present in 58/61 patients with a positive US study for intra-articular gout (95.1%).ConclusionsSensitivity of US for diagnosis of gouty arthritis in hand and wrist is limited, particularly with respect to extra-articular urate deposition. The DCS is the most sensitive sign for the assessment of gouty hand and wrist arthritis by US.Key points• Sensitivity of US for diagnosis of gouty arthritis in hand and wrist is limited, particularly with respect to extra-articular gouty deposits.• The double contour sign is the most sensitive finding for the assessment of gouty hand and wrist arthritis by US.• Although the sensitivity of US for diagnosis of gouty hand and wrist arthritis is limited, it can be used as a first-line imaging modality in the presence of the DCS.
Highlights
The incidence of gout has tripled over recent decades and represents the most common inflammatory arthritis in men and women [1,2,3,4].Long-term hyperuricemia results in deposition of monosodium urate (MSU) crystals in joints and soft tissues, triggering gouty arthritis and, if not properly treated, the formation of gouty tophi [5,6,7,8]
The sensitivity of US for diagnosis of gouty hand and wrist arthritis is limited, it can be used as a first-line imaging modality in the presence of the double contour sign (DCS)
Among the 83 patients with a negative dual-energy CT (DECT) study, the final alternative diagnosis was confirmed as osteoarthritis in 42/83 (50.6%), calcium pyrophosphate dehydrate deposition disease (CPPD) in 31/83 (37.3%) and hydroxyapatite deposition disease (HADD) in 10/83 (12%)
Summary
Long-term hyperuricemia results in deposition of monosodium urate (MSU) crystals in joints and soft tissues, triggering gouty arthritis and, if not properly treated, the formation of gouty tophi [5,6,7,8]. In the studies by Dalbeth [9] and Zhang et al [10], DECT is described as an advanced imaging method for longitudinal. Few studies have evaluated the feasibility of ultrasound (US) as compared to dual-energy CT (DECT), which can differentiate calcium-rich material (high attenuation) from MSU crystal-rich material (low attenuation) for the diagnosis of gout [14,15,16]. Manger et al [17] described periarticular gouty deposits in 9/12 hands and wrists, whereas Huppertz et al [18] presented overall results for multiple joints (knees, feet, elbows and hands) without detailed sonographic results for hands and wrists in their patient-based evaluation
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