Skip to main content

Advertisement

SpringerLink
Log in

Methods of assessment of tophus and bone erosions in gout using dual-energy CT: reproducibility analysis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

This study aims to evaluate the intraobserver and interobserver reproducibility of the tophus urate volume, erosion volume, and the erosion score measurements in patients with gout by using dual-energy CT (DECT) scans comparing their bone erosion volumes against bone erosion scores and also to determine a valid measure of joint destruction in chronic gout. Sixty-six subjects underwent DECT scans of the hands or feet. Two independent observers measured the tophus urate volumes and bone erosion volumes using automated volume assessment software and the erosion scores based on the rheumatoid arthritis magnetic resonance imaging score (RAMRIS). The intraobserver and interobserver reproducibility were analyzed by intraclass correlation coefficient (ICC) and limits of agreements analysis. The relationship between erosion volumes and erosion scores was analyzed. The intraobserver and interobserver ICC for tophus urate volume measurements (n = 636) were 1.000 (95 % confidence interval (95 % CI) 1.000 to 1.000) and 1.000 (95 % CI 1.000 to 1.000), 0.999 (0.999, 0.999) and 0.999 (0.999, 0.999) for bone erosion volumes (n = 350), 0.937 (0.928, 0.946) and 0.899 (0.883, 0.912) for erosion scores (n = 350). Strong positive correlations were demonstrated between individual erosion volumes and scores (r s = 0.914, p < 0.001) as well as total erosion volume and score per patient (r = 0.838-0.867, p < 0.001). This study demonstrated a high reproducibility of tophus urate volumes, erosion volumes, and erosion score measurements using DECT. Erosion volumes show to be a more direct and accurate method to evaluate bone erosion compared with erosion score, strongly supporting it as a superior and standard measure of structural joint damage in gout.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

MSU:

Monosodium urate

OMERACT:

The Outcome Measures in Rheumatology

US:

Ultrasonography

CT:

Computed tomography

MRI:

Magnetic resonance imaging

DECT:

Dual-energy computed tomography

RA:

Rheumatoid arthritis

RAMRIS:

Rheumatoid arthritis magnetic resonance imaging scoring system

CRP:

C-reactive protein

ICC:

Intraclass correlation coefficients

CI:

Confidence interval

CV:

Coefficient of variation

References

  1. Choi HK, Mount DB, Reginato AM (2005) Pathogenesis of gout. Ann Intern Med 143(7):499–516

    Article  CAS  PubMed  Google Scholar 

  2. Dalbeth N, Clark B, Gregory K, Gamble G, Sheehan T, Doyle A, McQueen FM (2009) Mechanisms of bone erosion in gout: a quantitative analysis using plain radiography and computed tomography. Ann Rheum Dis 68(8):1290–1295. doi:10.1136/ard.2008.094201

    Article  CAS  PubMed  Google Scholar 

  3. Dalbeth N, Smith T, Nicolson B, Clark B, Callon K, Naot D, Haskard DO, McQueen FM, Reid IR, Cornish J (2008) Enhanced osteoclastogenesis in patients with tophaceous gout: urate crystals promote osteoclast development through interactions with stromal cells. Arthritis Rheum 58(6):1854–1865. doi:10.1002/art.23488

    Article  CAS  PubMed  Google Scholar 

  4. Schumacher HR, Taylor W, Edwards L, Grainger R, Schlesinger N, Dalbeth N, Sivera F, Singh J, Evans R, Waltrip RW, Diaz-Torne C, MacDonald P, McQueen F, Perez-Ruiz F (2009) Outcome domains for studies of acute and chronic gout. J Rheumatol 36(10):2342–2345. doi:10.3899/jrheum.090370

    Article  PubMed  Google Scholar 

  5. Dalbeth N, Schauer C, Macdonald P, Perez-Ruiz F, Schumacher HR, Hamburger S, Choi HK, McQueen FM, Doyle A, Taylor WJ (2011) Methods of tophus assessment in clinical trials of chronic gout: a systematic literature review and pictorial reference guide. Ann Rheum Dis 70(4):597–604. doi:10.1136/ard.2010.139899

    Article  PubMed  Google Scholar 

  6. Desai MA, Peterson JJ, Garner HW, Kransdorf MJ (2011) Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics Rev Publ Radiol Soc N Am Inc 31(5):1365–1375. doi:10.1148/rg.315115510, discussion 1376-1367

    Google Scholar 

  7. Glazebrook KN, Guimaraes LS, Murthy NS, Black DF, Bongartz T, Manek NJ, Leng S, Fletcher JG, McCollough CH (2011) Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology 261(2):516–524. doi:10.1148/radiol.11102485

    Article  PubMed  Google Scholar 

  8. Choi HK, Al-Arfaj AM, Eftekhari A, Munk PL, Shojania K, Reid G, Nicolaou S (2009) Dual energy computed tomography in tophaceous gout. Ann Rheum Dis 68(10):1609–1612. doi:10.1136/ard.2008.099713

    Article  CAS  PubMed  Google Scholar 

  9. Choi HK, Burns LC, Shojania K, Koenig N, Reid G, Abufayyah M, Law G, Kydd AS, Ouellette H, Nicolaou S (2012) Dual energy CT in gout: a prospective validation study. Ann Rheum Dis. doi:10.1136/annrheumdis-2011-200976

    Google Scholar 

  10. Dalbeth N, Aati O, Gao A, House M, Liu Q, Horne A, Doyle A, McQueen FM (2012) Assessment of tophus size: a comparison between physical measurement methods and dual-energy computed tomography scanning. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 18(1):23–27. doi:10.1097/RHU.0b013e31823e5cda

    Google Scholar 

  11. Bird P, Lassere M, Shnier R, Edmonds J (2003) Computerized measurement of magnetic resonance imaging erosion volumes in patients with rheumatoid arthritis: a comparison with existing magnetic resonance imaging scoring systems and standard clinical outcome measures. Arthritis Rheum 48(3):614–624. doi:10.1002/art.10820

    Article  PubMed  Google Scholar 

  12. Dohn UM, Ejbjerg BJ, Court-Payen M, Hasselquist M, Narvestad E, Szkudlarek M, Moller JM, Thomsen HS, Ostergaard M (2006) Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther 8(4):R110. doi:10.1186/ar1995

    Article  PubMed Central  PubMed  Google Scholar 

  13. Dohn UM, Ejbjerg BJ, Hasselquist M, Narvestad E, Court-Payen M, Szkudlarek M, Moller J, Thomsen HS, Ostergaard M (2007) Rheumatoid arthritis bone erosion volumes on CT and MRI: reliability and correlations with erosion scores on CT, MRI and radiography. Ann Rheum Dis 66(10):1388–1392. doi:10.1136/ard.2007.072520

    Article  PubMed Central  PubMed  Google Scholar 

  14. Conaghan P, Bird P, Ejbjerg B, O'Connor P, Peterfy C, McQueen F, Lassere M, Emery P, Shnier R, Edmonds J, Ostergaard M (2005) The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the metacarpophalangeal joints. Ann Rheum Dis 64(Suppl 1):i11–i21. doi:10.1136/ard.2004.031815

    Article  PubMed Central  PubMed  Google Scholar 

  15. Dalbeth N, Doyle A, Boyer L, Rome K, Survepalli D, Sanders A, Sheehan T, Lobo M, Gamble G, McQueen FM (2011) Development of a computed tomography method of scoring bone erosion in patients with gout: validation and clinical implications. Rheumatology (Oxford) 50(2):410–416. doi:10.1093/rheumatology/keq335

    Article  Google Scholar 

  16. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20(3):895–900

    Article  CAS  PubMed  Google Scholar 

  17. Yu L, Primak AN, Liu X, McCollough CH (2009) Image quality optimization and evaluation of linearly mixed images in dual-source, dual-energy CT. Med Phys 36(3):1019–1024

    Article  PubMed Central  PubMed  Google Scholar 

  18. Dhanda S, Jagmohan P, Quek ST (2011) A re-look at an old disease: a multimodality review on gout. Clin Radiol 66(10):984–992. doi:10.1016/j.crad.2011.04.011

    Article  CAS  PubMed  Google Scholar 

  19. Carter JD, Kedar RP, Anderson SR, Osorio AH, Albritton NL, Gnanashanmugam S, Valeriano J, Vasey FB, Ricca LR (2009) An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology (Oxford) 48(11):1442–1446. doi:10.1093/rheumatology/kep278

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank the Rheumatology and Radiology Department staff memebers of the Second Affiliated Hospital of Zhejiang University School of Medicine for providing patient information and giving valuable comments and advice for the study.

Disclosures

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, Hangzhou, 310009, China

    Dan Shi, Jian-Xia Xu, Ying Wang, Qi-Jing Zhou & Ri-Sheng Yu

  2. Department of Rheumatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, Hangzhou, 310009, China

    Hua-Xiang Wu

Authors
  1. Dan Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian-Xia Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hua-Xiang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ying Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qi-Jing Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ri-Sheng Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ri-Sheng Yu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, D., Xu, JX., Wu, HX. et al. Methods of assessment of tophus and bone erosions in gout using dual-energy CT: reproducibility analysis. Clin Rheumatol 34, 755–765 (2015). https://doi.org/10.1007/s10067-014-2725-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-014-2725-9

Keywords

Search

Navigation