This chapter explores the technique of dual energy computed tomography (DECT) and the current and future clinical use of DECT in the diagnosis and management of gouty arthropathy.
Gout is a common type of crystalline arthropathy of metabolic origin. Both the incidence and prevalence of gout appear to be increasing worldwide. It is triggered by the crystallization of monosodium urate (MSU) within joints which is characterized by intermittent attacks of inflammation. Gout causes significant pain, activity limitation and can be a substantial cause of morbidity. The definitive diagnosis of gout requires microscopic analysis of fluid aspirated from the joint; however, many physicians diagnose and manage gout without confirming the diagnosis with joint aspirate crystal analysis. There is limited clinical utility among the current imaging modalities used to identify and monitor gout including X-rays, ultrasound, conventional computed tomography, and magnetic resonance imaging which all lack specificity for gout. Dual energy CT can accurately characterize MSU deposition and can improve clinical diagnoses of unclear arthropathies. DECT has the potential to be a problem-solving tool that can be utilized to diagnose the presence of gout in challenging clinical presentations and potentially obviating the need for arthrocentesis.
DECT has the potential to revolutionize the diagnosis and management of gout.
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