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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.
Highlights
BackgroundGout is a crystal-induced inflammatory arthritis, which is one of the oldest and commonest rheumatic diseases [1,2]
Gout is characterized clinically by acute onset of inflammatory mono-/ oligoarthritis and is often difficult to distinguish from other inflammatory arthritides without confirmation by synovial fluid analysis
A study by Petsch, et al observed that a considerable number of seronegative rheumatoid arthritis (RA) patients with hyperuricemia had periarticular monosodium urate (MSU) crystal deposits in Dual energy computed tomography (DECT) scan
Summary
Gout is a crystal-induced inflammatory arthritis, which is one of the oldest and commonest rheumatic diseases [1,2]. The detection of MSU crystals in the symptomatic joints on DECT scan is sufficient for the diagnosis of gout [9] This is based on the Study for Updated Gout Classification Criteria (SUGAR) and includes clinical, laboratory, and imaging characteristics of gout. A study by Petsch, et al observed that a considerable number of seronegative rheumatoid arthritis (RA) patients with hyperuricemia had periarticular MSU crystal deposits in DECT scan This finding suggested that some patients fulfilling ACR/EULAR criteria for RA may be suffering from polyarticular gout. This is detailed in a study by Bongartz, et al, where 20% of patients with no prior history of gout failed to demonstrate MSU crystals on DECT imaging This was attributed to the increasingly small size of deposits in early disease [14].
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