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Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value?

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Abstract

Objectives

To evaluate the ability of dual-energy computed tomography (DECT) to improve diagnostic discrimination between gout and other crystal arthropathies such as calcium pyrophosphate deposition disease (CPPD) of the wrist in a clinical patient population.

Materials and methods

This retrospective case-control study included 29 patients with either gout (case group; n = 9) or CPPD (control group; n = 20) who underwent DECT of the wrist for clinically suspected crystal arthropathy. Color-coded urate and enhanced calcium as well as virtual 120 kVe blended images were reconstructed from the DECT datasets. Two independent and blinded readers evaluated each reconstructed dataset for the presence of depositions in 17 predefined regions. Additionally, a global diagnosis was made first for 120 kVe images only, based solely on morphologic criteria, and subsequently for all reconstructed images.

Results

Sensitivity for the global diagnosis of gout was 1.0 (95% CI 0.63–1) for both DECT and 120 kVe images with specificities of 0.70 (95% CI 0.46–0.87) for DECT and 0.80 (95% CI 0.56–0.93) for 120 kVe images. Color-coded DECT images did not detect more depositions than monochrome standard CT images.

Conclusion

Discrimination of crystal arthropathies of the wrist is limited using DECT and primarily relying on color-coded images. Evaluation of morphologic criteria on standard CT images is essential for accurate diagnosis.

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References

  1. Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis. 2008;67(7):960–6.

    Article  CAS  Google Scholar 

  2. Richette P, Clerson P, Bouee S, Chales G, Doherty M, Flipo RM, et al. Identification of patients with gout: elaboration of a questionnaire for epidemiological studies. Ann Rheum Dis. 2015;74(9):1684–90.

    Article  CAS  Google Scholar 

  3. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789–98.

    Article  CAS  Google Scholar 

  4. Swan A, Amer H, Dieppe P. The value of synovial fluid assays in the diagnosis of joint disease: a literature survey. Ann Rheum Dis. 2002;61(6):493–8.

    Article  CAS  Google Scholar 

  5. McCollough CH, Leng S, Yu L, Fletcher JG. Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology. 2015;276(3):637–53.

    Article  Google Scholar 

  6. Ogdie A, Taylor WJ, Weatherall M, Fransen J, Jansen TL, Neogi T, et al. Imaging modalities for the classification of gout: systematic literature review and meta-analysis. Ann Rheum Dis. 2015;74(10):1868–74.

    Article  Google Scholar 

  7. Diekhoff T, Kiefer T, Stroux A, Pilhofer I, Juran R, Mews J, et al. Detection and characterization of crystal suspensions using single-source dual-energy computed tomography: a phantom model of crystal arthropathies. Investig Radiol. 2015;50(4):255–60.

    Article  Google Scholar 

  8. Bongartz T, Glazebrook KN, Kavros SJ, Murthy NS, Merry SP, Franz WB 3rd, et al. Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. Ann Rheum Dis. 2015;74(6):1072–7.

    Article  CAS  Google Scholar 

  9. Choi HK, Burns LC, Shojania K, Koenig N, Reid G, Abufayyah M, et al. Dual energy CT in gout: a prospective validation study. Ann Rheum Dis. 2012;71(9):1466–71.

    Article  Google Scholar 

  10. Baer AN, Kurano T, Thakur UJ, Thawait GK, Fuld MK, Maynard JW, et al. Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout. BMC Musculoskelet Disord. 2016;17:91.

    Article  Google Scholar 

  11. Notzel A, Hermann KG, Feist E, Kedor C, Ziegeler K, Stroux A, et al. Diagnostic accuracy of dual-energy computed tomography and joint aspiration: a prospective study in patients with suspected gouty arthritis. Clin Exp Rheumatol. 2018;36(6):1061–7.

    PubMed  Google Scholar 

  12. Rosenthal AKRL, DJ MC. Calcium pyrophosphate crystal deposition disease, pseudogout, and articular chondrocalcinosis. In: ML KWJ, editor. Arthritis and Allied Conditions. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 2373.

    Google Scholar 

  13. Ziegeler K, Diekhoff T, Hermann S, Hamm B, Hermann KGA. Low-dose computed tomography as diagnostic tool in calcium pyrophosphate deposition disease arthropathy: focus on ligamentous calcifications of the wrist. Clin Exp Rheumatol. 2019.

  14. Saltybaeva N, Jafari ME, Hupfer M, Kalender WA. Estimates of effective dose for CT scans of the lower extremities. Radiology. 2014;273(1):153–9.

    Article  Google Scholar 

  15. Gosch D, Gosch K, Kahn T. Conversion coefficients for estimation of effective dose to patients from dose area product during fluoroscopy x-ray examinations. Rofo. 2007;179(10):1035–42.

    Article  CAS  Google Scholar 

  16. Glazebrook KN, Guimaraes LS, Murthy NS, Black DF, Bongartz T, Manek NJ, et al. Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology. 2011;261(2):516–24.

    Article  Google Scholar 

  17. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70(4):563–70.

    Article  CAS  Google Scholar 

  18. Magarelli N, Amelia R, Melillo N, Nasuto M, Cantatore F, Guglielmi G. Imaging of chondrocalcinosis: calcium pyrophosphate dihydrate (CPPD) crystal deposition disease -- imaging of common sites of involvement. Clin Exp Rheumatol. 2012;30(1):118–25.

    CAS  PubMed  Google Scholar 

  19. Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 2011;31(5):1365–75 discussion 1376-1367.

    Article  Google Scholar 

  20. Dalbeth N, Choi HK. Dual-energy computed tomography for gout diagnosis and management. Curr Rheumatol Rep. 2013;15(1):301.

    Article  Google Scholar 

  21. Naslund U, Ng N, Lundgren A, Fharm E, Gronlund C, Johansson H, et al. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet. 2019;393(10167):133–42.

    Article  Google Scholar 

  22. Diekhoff T, Scheel M, Hermann S, Mews J, Hamm B, Hermann KA. Osteitis: a retrospective feasibility study comparing single-source dual-energy CT to MRI in selected patients with suspected acute gout. Skelet Radiol. 2017;46(2):185–90.

    Article  Google Scholar 

  23. Wu H, Zhang G, Huang X, Liang C. Use of dual-energy CT to detect and depict bone marrow oedema in rheumatoid arthritis: is it ready to substitute MRI? Ann Rheum Dis. 2018;78:e89.

    Article  Google Scholar 

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Acknowledgments

We wish to thank Mr Jürgen Mews for technical support and Mrs Bettina Herwig for language editing of the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Katharina Ziegeler, Kay Geert A. Hermann, Bernd Hamm & Torsten Diekhoff

  2. Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Sandra Hermann

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  1. Katharina Ziegeler
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  2. Sandra Hermann
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  3. Kay Geert A. Hermann
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  4. Bernd Hamm
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  5. Torsten Diekhoff
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Corresponding author

Correspondence to Katharina Ziegeler.

Ethics declarations

The local ethics review board waived approval of this study due to its retrospective nature. Prior to the CT examination, patients gave written informed consent to the scientific use of imaging and clinical data, which is the standard procedure at our institution.

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The authors declare that they have no conflict of interest.

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Ziegeler, K., Hermann, S., Hermann, K.G.A. et al. Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value?. Skeletal Radiol 49, 707–713 (2020). https://doi.org/10.1007/s00256-019-03343-5

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  • DOI: https://doi.org/10.1007/s00256-019-03343-5

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