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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
Musculoskeletal
  • 226 Downloads

Abstract

Objectives

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

Methods

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.

Results

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.

Conclusion

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.

Keywords

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

Abbreviations

ACR

American College of Rheumatology

AUC

Area under receiver operating characteristic curve

CPPD

Calcium pyrophosphate deposition disease

DECT

Dual-energy computed tomography

EULAR

European League Against Rheumatism classification

MSU

Monosodium urate

MTP

Metatarsophalangeal

NCCT

Non-contrast computed tomography

ROC

Receiver operating characteristic

Notes

Funding

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

Compliance with ethical standards

Guarantor

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.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

References

  1. 1.
    Girish G, Melville DM, Kaeley GS et al (2013) Imaging appearances in gout. Arthritis.  https://doi.org/10.1155/2013/673401
  2. 2.
    Dalbeth N, Pool B, Gamble GD et al (2010) Cellular characterization of the gouty tophus: a quantitative analysis. Arthritis Rheum 62:1549–1556CrossRefGoogle Scholar
  3. 3.
    Monu JU, Pope TL Jr (2004) Gout: a clinical and radiologic review. Radiol Clin North Am 42:169–184CrossRefGoogle Scholar
  4. 4.
    Terkeltaub R (2010) Update on gout: new therapeutic strategies and options. Nat Rev Rheumatol 6:30–38CrossRefGoogle Scholar
  5. 5.
    Schlesinger N, Dalbeth N, Perez-Ruiz F (2009) Gout--what are the treatment options? Expert Opin Pharmacother 10:1319–1328CrossRefGoogle Scholar
  6. 6.
    Choi HK, Al-Arfaj AM, Eftekhari A et al (2009) Dual energy computed tomography in tophaceous gout. Ann Rheum Dis 68:1609–1612CrossRefGoogle Scholar
  7. 7.
    Glazebrook KN, Guimarães LS, Murthy NS et al (2011) Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology 261:516–524CrossRefGoogle Scholar
  8. 8.
    Choi HK, Burns LC, Shojania K et al (2012) Dual energy CT in gout: a prospective validation study. Ann Rheum Dis 71:1466–1471CrossRefGoogle Scholar
  9. 9.
    Neogi T, Jansen TL, Dalbeth N et al (2015) 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 67:2557–2568CrossRefGoogle Scholar
  10. 10.
    Baer AN, Kurano T, Thakur UJ et al (2016) Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout. BMC Musculoskelet Disord.  https://doi.org/10.1186/s12891-016-0943-9
  11. 11.
    Bongartz T, Glazebrook KN, Kavros SJ et al (2015) Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. Ann Rheum Dis 74:1072–1077CrossRefGoogle Scholar
  12. 12.
    Dalbeth N, House ME, Aati O et al (2015) Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis 74:908–911CrossRefGoogle Scholar
  13. 13.
    Jia E, Zhu J, Huang W, Chen X, Li J (2017) Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout. Clin Rheumatol.  https://doi.org/10.1007/s10067-017-3753-z
  14. 14.
    Finkenstaedt T, Manoliou A, Toniolo M et al (2016) Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT. Eur Radiol 26:3989–3999CrossRefGoogle Scholar
  15. 15.
    Werncke T, Meyer BC, Wacker FK, von Falck C (2014) Virtual single-source computed tomography using dual-source acquisition: a new technique for the dose-neutral intraindividual comparison of different scan protocols. Invest Radiol 49:742–748CrossRefGoogle Scholar
  16. 16.
    Taylor WJ, Fransen J, Jansen TL et al (2015) Study for updated gout classification criteria: identification of features to classify gout. Arthritis Care Res (Hoboken) 67:1304–1315CrossRefGoogle Scholar
  17. 17.
    Glazebrook KN, Kakar S, Ida CM, Laurini JA, Moder KG, Leng S (2012) False-negative dual-energy computed tomography in a patient with acute gout. J Clin Rheumatol 18:138–141CrossRefGoogle Scholar
  18. 18.
    Melzer R, Pauli C, Treumann T, Krauss B (2014) Gout tophus detection-a comparison of dual-energy CT (DECT) and histology. Semin Arthritis Rheum 43:662–665CrossRefGoogle Scholar
  19. 19.
    Diekhoff T, Kiefer T, Stroux A et al (2015) Detection and characterization of crystal suspensions using single-source dual-energy computed tomography: a phantom model of crystal arthropathies. Invest Radiol 50:255–260CrossRefGoogle Scholar
  20. 20.
    Naredo E, Uson J, Jiménez-Palop M et al (2014) Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis 73:1522–1528CrossRefGoogle Scholar
  21. 21.
    Wang Q, Guo LH, Li XL et al (2018) Differentiating the acute phase of gout from the intercritical phase with ultrasound and quantitative shear wave elastography. Eur Radiol.  https://doi.org/10.1007/s00330-018-5529-5
  22. 22.
    Zhu L, Zheng S, Wang W, Zhou Q, Wu H (2017) Combining hyperechoic aggregates and the double-contour sign increases the sensitivity of sonography for detection of monosodium urate deposits in gout. J Ultrasound Med 36:935–940CrossRefGoogle Scholar
  23. 23.
    Klauser AS, Halpern EJ, Strobl S et al (2018) Gout of hand and wrist: the value of US as compared with DECT. Eur Radiol.  https://doi.org/10.1007/s00330-018-5363-9
  24. 24.
    Rosenthal AK, Ryan LM (2016) Calcium pyrophosphate deposition disease. N Engl J Med 374:2575–2584CrossRefGoogle Scholar
  25. 25.
    Wu H, Xue J, Ye L, Zhou Q, Shi D, Xu R (2014) The application of dual-energy computed tomography in the diagnosis of acute gouty arthritis. Clin Rheumatol 33:975–979CrossRefGoogle Scholar
  26. 26.
    Sun Y, Ma L, Zhou Y et al (2015) Features of urate deposition in patients with gouty arthritis of the foot using dual-energy computed tomography. Int J Rheum Dis 18:560–567CrossRefGoogle Scholar
  27. 27.
    Hu HJ, Liao MY, Xu LY (2015) Clinical utility of dual-energy CT for gout diagnosis. Clin Imaging 39:880–885CrossRefGoogle Scholar
  28. 28.
    Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20:895–900CrossRefGoogle Scholar
  29. 29.
    Yu L, Christner JA, Leng S, Wang J, Fletcher JG, McCollough CH (2011) Virtual monochromatic imaging in dual-source dual-energy CT: radiation dose and image quality. Med Phys 38:6371–6379CrossRefGoogle Scholar
  30. 30.
    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 36:1019–1024CrossRefGoogle Scholar
  31. 31.
    Mileto A, Nelson RC, Samei E et al (2014) Dual-energy MDCT in hypervascular liver tumors: effect of body size on selection of the optimal monochromatic energy level. AJR Am J Roentgenol 203:1257–1264CrossRefGoogle Scholar
  32. 32.
    Grant KL, Flohr TG, Krauss B, Sedlmair M, Thomas C, Schmidt B (2014) Assessment of an advanced image-based technique to calculate virtual monoenergetic computed tomographic images from a dual-energy examination to improve contrast-to-noise ratio in examinations using iodinated contrast media. Invest Radiol 49:586–592CrossRefGoogle Scholar
  33. 33.
    Khanna D, Fitzgerald JD, Khanna PP et al (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 64:1431–1446CrossRefGoogle Scholar
  34. 34.
    Khanna D, Khanna PP, Fitzgerald JD et al (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken) 64:1447–1461CrossRefGoogle Scholar

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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