Combining non-contrast and dual-energy CT improves diagnosis of early gout
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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.
• 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.
KeywordsGout 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
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.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• Diagnostic or prognostic study
• Performed at one institution
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