Abstract
ObjectivesTo investigate the frequency of monosodium urate (MSU) crystal deposits on dual-energy computed tomography (DECT) in patients with clinical diagnosis of gout and the factors associated MSU crystal positivity.MethodsThis study was conducted in patients with clinical diagnosis of gout who underwent DECT. Clinical features were compared between patients with positive and those with negative DECT results. A logistic regression analysis was performed to determine the factors associated with MSU crystal positivity on DECT.ResultsA total of 148 patients with clinical diagnosis of gout were included, and MSU crystal deposition on DECT was observed in 64 patients (43.3%). The patients with positive DECT results were more likely to have renal insufficiency, longer disease duration, and higher serum urate level than those with negative. In the multivariable analysis, first gout attack (odds ratio 0.462; 95% confidence interval 0.229–0.931, p = 0.031) was associated with a less likely MSU crystal deposit-positive DECT result. In the subgroup analysis of patients with first attack, serum urate level > 8 mg/dL was associated with DECT positivity.ConclusionOf the patients with clinical diagnosis of gout, those with renal insufficiency, longer disease duration, and high serum urate level were more likely to be positive of gout on DECT. First gout attack was associated with less likely to be positive for MSU crystal on DECT. Thus, performing DECT scan in the selected patients who had characteristics that highly probability of DECT positivity could increase positive predictive value.
Highlights
Gout is caused by the deposition of monosodium urate (MSU) crystals in the joints, cartilage, and soft tissues
In this study, we aimed to examine the clinical characteristics of patients with positive MSU crystals on dual-energy computed tomography (DECT) in comparison with patients with negative MSU crystals and the factors associated with DECT positivity
A logistic regression analysis with a backward elimination procedure was performed to identify the factors associated with DECT positivity
Summary
Gout is caused by the deposition of monosodium urate (MSU) crystals in the joints, cartilage, and soft tissues. It is the most common inflammatory arthritis in the West, and its prevalence is constantly increasing in Korea [1]. An important test in diagnosing gout is to check for MSU crystals under polarizing microscopy through joint fluid aspiration in the affected joint [2]. In the case of the first metatarsal joint, puncture is not easy it may be difficult to confirm the presence of MSU crystals under polarizing microscopy. When the presence of MSU crystal deposits cannot be confirmed by synovial fluid examination, imaging could be used as a diagnostic tool in patients with suspected gout.
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