Abstract
BackgroundUltrasonography (US) and dual-energy computed tomography (DECT) can assess urate burden in gout. The objective of this study was to compare the quantification of urate deposition provided by US to the one provided by DECT.MethodsPatients with a diagnosis of gout were prospectively recruited to undergo quantification of urate deposition using US and DECT. US examination for tophi and the double contour (DC) sign was performed on the knees and feet and corresponding DECT scans provided volumes of tophi and of overall urate deposition. The primary endpoint was the intra-class correlation coefficient (ICC) of the volume of the index tophus measured by US and DECT and its 95% confidence interval (CI 95%).ResultsOf the 64 patients included, 34 presented with at least one tophus on US. DECT inter-reader agreement for urate deposition was perfect with an ICC of 1 (1–1) and good for the measurement of the index tophus with an ICC of 0.69 (0.47–0.83). The ICC for the measurement of the index tophus between the two techniques was poor with a value of 0.45 (0.1–0.71). The average ratio between the index tophi volume as assessed by DECT and US was 0.65. The number of DC-positive joints did not correlate with DECT volume of overall deposits (Spearman correlation coefficient of 0.23).ConclusionsDECT measurements of tophi give smaller volumes to the same tophi measured with US, and US signs of urate deposition in joints do not correlate with overall DECT volumes of extra-articular deposition.
Highlights
Ultrasonography (US) and dual-energy computed tomography (DECT) can assess urate burden in gout
Two techniques are promising in that respect: ultrasonography (US) and dual-energy computed tomography (DECT)
We investigated the concordance between techniques in assessment of tophus volume assessment, and the correlation between US signs and the volume of urate deposits measured by DECT
Summary
Ultrasonography (US) and dual-energy computed tomography (DECT) can assess urate burden in gout. Gout is a common inflammatory form of arthritis that develops after a history of hyperuricemia and subsequent urate deposition within joints and soft tissues [1]. DECT provides measurement of the volume of tophaceous and non-tophaceous soft tissue urate deposits with the limitation of spatial resolution [9]. The sensitivity of DECT for urate deposits in soft tissues has been mainly used for diagnostic purposes [10]. Both techniques have independently shown sensitivity to changes in urate deposits visualised after treatment [11,12,13]. Despite the fact that US and DECT are both candidates to quantify urate deposition and monitor urate depletion [17, 18], it is still unknown whether these techniques provide the same quantification of the extent of urate deposition in a given patient
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