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Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT

  • Computed Tomography
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Abstract

Objectives

To determine the diagnostic and therapeutic impact of dual-energy computed tomography (DECT) in gout.

Methods

Forty-three patients with (n = 20) and without a history of gout (n = 23) showing non-specific soft tissue deposits underwent DECT after unrewarding arthrocentesis. Two blinded, independent readers evaluated DECT for the presence of urate crystals. Clinical diagnosis, clinically suspected urate crystal locations, diagnostic thinking and therapeutic decisions were noted before and after DECT. Clinical 1-month follow-up was obtained.

Results

DECT showed urate in 26/43 patients (60 %). After DECT, clinical diagnosis of gout was withdrawn in 17/43 (40 %) and was maintained in 16/43 patients (37 %). In 10/43 patients (23 %) the diagnosis was maintained, but DECT revealed urate in clinically unsuspected locations. In 23/43 patients (53 %), a treatment-change based on DECT occurred. Changes in diagnostic thinking occurred more frequently in patients without a history of gout (p < 0.001), changes in therapeutic decisions more frequently in patients with a history of gout (p = 0.014). Clinical follow-up indicated beneficial effects of DECT-based diagnoses in 83 % of patients.

Conclusions

In patients with or without a history of gout and a recent suspicion for gouty arthritis with an unrewarding arthrocentesis, DECT has a marked diagnostic and therapeutic impact when hyperdense soft-tissue deposits are present.

Key Points

• This study evaluates the concept of evidence-based radiology

• In patients with suspected gout, DECT can help clinicians make the diagnosis

• DECT has a marked impact on therapy

• Clinical follow-up after 1 month indicated reliable results of DECT

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Abbreviations

AAD:

Acute anti-inflammatory drugs

CPPD:

Calcium pyrophosphate dihydrate deposition disease

DECT:

Dual-energy computed tomography

EBR:

Evidence-based radiology

SD:

Standard deviation

UALD:

Uric-acid-lowering drugs

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Acknowledgements

The scientific guarantor of this publication is Hatem Alkadhi, MD, MPH, EBCR. 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. The authors state that this work has not received any funding.

One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: Retrospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Tim Finkenstaedt, Andrei Manoliou, Kai Higashigaito, Gustav Andreisek, Roman Guggenberger & Hatem Alkadhi

  2. Department of Rheumatology, University Hospital Zurich and University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland

    Martin Toniolo & Beat Michel

Authors
  1. Tim Finkenstaedt
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  2. Andrei Manoliou
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  3. Martin Toniolo
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  8. Hatem Alkadhi
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Correspondence to Hatem Alkadhi.

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Finkenstaedt, T., Manoliou, A., Toniolo, M. et al. Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT. Eur Radiol 26, 3989–3999 (2016). https://doi.org/10.1007/s00330-016-4237-2

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  • DOI: https://doi.org/10.1007/s00330-016-4237-2

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