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Differentiating the acute phase of gout from the intercritical phase with ultrasound and quantitative shear wave elastography

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate the value of ultrasound (US) in differentiating the acute phase of gout from the intercritical phase, particularly using shear wave elastography (SWE).

Methods

57 gout patients were prospectively enrolled and divided into acute phase and intercritical phase groups. The patients underwent US and SWE examinations for the first metatarsophalangeal joints with the same protocol. Maximum synovial thickness was measured. US features were reviewed by two radiologists independently. The maximum (Emax) and mean (Emean) elastic moduli of synovium were calculated. Diagnostic performances of US, SWE and combined US and SWE were evaluated.

Results

US findings demonstrated that the colour Doppler flow signal grade in the acute phase was higher than that in the intercritical phase (p = 0.001), whereas no differences were found for B-mode US features between the two groups (all p > 0.05). For SWE, Emax and Emean were significantly higher in the intercritical phase than in the acute phase (both p < 0.001). The areas under the receiver operating characteristic curve (AUROCs) were 0.494–0.553 for B-mode US, 0.735 for colour Doppler US (CDUS), 0.887 for Emax and 0.882 for Emean. The combination of CDUS and SWE increased the AUROC, sensitivity and accuracy significantly in comparison with CDUS alone (all p < 0.001). However, the combined set did not show stronger diagnostic performance in comparison with SWE alone.

Conclusion

SWE increases the diagnostic performance in differentiating the acute phase of gout from the intercritical phase in comparison with conventional US.

Key Points

• Colour Doppler flow signal grade is higher in acute phase of gout than in intercritical phase.

• SWE demonstrates that synovium stiffness is higher in intercritical phase of gout than in acute phase.

• SWE increases diagnostic performance in differentiating acute phase of gout from intercritical phase in comparison with conventional US.

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Abbreviations

ACR:

American College of Rheumatology

AUROC:

Area under the receiver operating characteristic curve

CDUS:

Colour Doppler ultrasound

DCS:

Double-contour sign

EULAR:

European League Against Rheumatism

MSU:

Monosodium urate

MTPJ:

Metatarsophalangeal joint

NPV:

Negative predictive value

PPV:

Positive predictive value

SWE:

Shear wave elastrography

US:

Ultrasound

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Funding

This study has received funding by the Shanghai Hospital Development Center (Grant 16CR3061B), the Science and Technology Commission of Shanghai Municipality (Grants 14441900900 and 16411971100) and the National Nature Science Foundation of China (Grant 81725008).

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Authors and Affiliations

  1. Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, 301 Yanchangzhong Rd, Shanghai, 200072, China

    Qiao Wang, Le-Hang Guo, Xiao-Long Li, Chong-Ke Zhao, Ming-Xu Li & Hui-Xiong Xu

  2. Department of Nephrology and Rheumatology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchangzhong Rd, Shanghai, 200072, China

    Ling Wang & Xin-Ying Liu

Authors
  1. Qiao Wang
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  2. Le-Hang Guo
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  3. Xiao-Long Li
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  4. Chong-Ke Zhao
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  5. Ming-Xu Li
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  6. Ling Wang
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  7. Xin-Ying Liu
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  8. Hui-Xiong Xu
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Corresponding authors

Correspondence to Le-Hang Guo or Hui-Xiong Xu.

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Guarantor

The scientific guarantor of this publication is Hui-Xiong Xu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• diagnostic study

• performed at one institution

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Wang, Q., Guo, LH., Li, XL. et al. Differentiating the acute phase of gout from the intercritical phase with ultrasound and quantitative shear wave elastography. Eur Radiol 28, 5316–5327 (2018). https://doi.org/10.1007/s00330-018-5529-5

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  • DOI: https://doi.org/10.1007/s00330-018-5529-5

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