European Radiology

, Volume 29, Issue 3, pp 1267–1275 | Cite as

Combining non-contrast and dual-energy CT improves diagnosis of early gout

  • Seul Ki Lee
  • Joon-Yong JungEmail author
  • Won-Hee Jee
  • Jennifer Jooha Lee
  • Sung-Hwan Park



To determine the incremental value of non-contrast CT (NCCT) on dual-energy CT (DECT) in symptomatic first metatarsophalangeal (MTP) joints in early gout.


One hundred and fifteen painful joints were consecutively enrolled and gout was diagnosed based on the 2015 EULAR/ACR criteria and/or arthrocentesis. Two readers independently evaluated DECT alone and combined NCCT and DECT (NCCT+DECT) based on four semiquantitative scales. Sensitivities and specificities were compared using McNemar’s test. AUC was compared.


Of the 115 joints, 72 were defined as an early gout group and 43 as a gout-negative group after exclusion. The sensitivity and specificity for the early gout group on DECT alone were as followed: reader 1 – 52.8% and 100.0% and reader 2 – 51.4% and 100.0%. NCCT+DECT results were as follows: reader 1 – 79.2% and 93.0% and reader 2 – 79.2% and 95.3%. AUC was significantly higher in NCCT+DECT compared to that in DECT alone for the early gout group (0.888 vs. 0.774 for reader 1, p = 0.0004; 0.896 vs. 0.816 for reader 2, p = 0.0142). The false-negative cases on DECT occurred more frequently with the first-onset gout, and tended to be affected by a longer duration of symptoms in the post-hoc analysis.


The combined analysis of NCCT and DECT improves diagnostic capabilities in symptomatic early gout involving the first MTP joint.

Key Points

• MSU crystal depositions in early gout may be seen on non-contrast CT, while still being undetectable by DECT.

• Combining non-contrast CT and DECT improves detection of early gout.

• False negatives of DECT are more common than previously reported in cases of first-onset gout.


Gout Metatarsophalangeal joint Tomography, x-ray computed Dual-energy CT Uric acid 



American College of Rheumatology


Area under receiver operating characteristic curve


Calcium pyrophosphate deposition disease


Dual-energy computed tomography


European League Against Rheumatism classification


Monosodium urate




Non-contrast computed tomography


Receiver operating characteristic



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Joon-Yong Jung.

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

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Seul Ki Lee
    • 1
    • 2
  • Joon-Yong Jung
    • 1
    Email author
  • Won-Hee Jee
    • 1
  • Jennifer Jooha Lee
    • 3
  • Sung-Hwan Park
    • 3
  1. 1.Department of Radiology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Department of RadiologyDongguk University Ilsan HospitalGyenggi-doRepublic of Korea
  3. 3.Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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