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Associations between total urate deposit score and demographics, gout characteristics, diuretic and ULT use, BMI and renal function
Source publication
Background:
A definite diagnosis of gout requires demonstration of monosodium urate crystals in synovial fluid or in tophi, which in clinical practice today seldom is done. Dual energy CT (DECT) has repeatedly been shown to be able to detect monosodium urate crystals in tissues, hence being an alternative method to synovial fluid microscopy. The v...
Context in source publication
Context 1
... total urate deposit score was significantly higher in the presence of tophus (p = 0.0005) and correlated strongly to disease duration (Spearman Rho 0.64, p < .0001) while no association or correlation was seen to age, gender, erosive disease, urate levels, BMI, diuretic use, ULT use or renal function (Table 3). ...Similar publications
Gout is a common type of inflammatory arthritis characterized by the presence of monosodium urate crystals (MSU) in the joints. Macrophages are believed to be involved in gout flares. It has long been recognized that resident macrophage and monocyte derived macrophages are distinct subsets and there have been attempts to investigate their roles in...
Citations
... The electrode density and Zeff obtained with DECT are helpful for dose calculation in proton therapy and for distinguishing tissue components such as renal stones and tumor types. Among a growing list of diagnostic applications, lung ventilation mapping, gout imaging, and VNCa mapping have been increasingly used for pulmonary embolism, gout visualization, and bone marrow edema (6)(7)(8). In addition, the multimaterial differentiation or labeling method can be used for the quantitative analysis of specific substances, such as fat and iron (9). ...
Background
Dual-energy computed tomography (DECT) has received extensive attention in clinical practice; however, a quantitative assessment of published literature in this domain is presently lacking. This study thus aimed to characterize the application conditions, developmental trends, and research hot spots of DECT using bibliometric analysis.
Methods
All literature on DECT was retrieved from the Web of Science Core Collection (WoSCC) on January 22, 2023. The co-occurrence, cooperation network, and co-citation of countries, institutions, references, authors, journals, and keywords were analyzed using CiteSpace, VOSviewer, and R-bibliometrix software.
Results
In total, 4,720 original articles and reviews were included. The number of publications related to DECT has rapidly increased since 2006. The USA (n=1,662) and Mayo Clinic (n=178) were found to be the most productive country and institution, respectively. The most cited article was published by Johnson TRC et al., while the article published by McCollough CH et al. in 2015 had the most co-citations. Schoepf UJ ranked first with most articles among 16,838 authors. The journal with the most published articles was European Radiology, with 411 publications. The timeline analysis indicated that material decomposition was the most recent topic, followed by gout, radiomics, proton therapy, and bone marrow edema.
Conclusions
An increasing number of researchers are committed to researching DECT, with the USA making the most significant contributions in this area. Prior studies have primarily concentrated on cardiovascular diseases, and contemporary hot spots include expansion into to other fields, such as iodine quantification, deep learning, and bone marrow edema.
... Patients with higher volumes of MSU crystal deposits are likely to develop joint erosion. [20] As our results showed, some studies demonstrated that the total DECT urate score was highly positively correlated with urate deposit volumes. [13] Some studies have applied this urate scoring system and observed that a higher total urate score is closely associated with longer disease duration and bone erosion. ...
The purpose of this study was to investigate the diagnostic performance of a novel semi-quantitative dual-energy computed tomography (DECT) scoring system in monitoring urate deposition. This study included 287 patients with gout. All patients underwent ankle/foot DECT scans. DECT scores at different stages were compared and their diagnostic efficacies evaluated. Associations between DECT scores and clinical variables were evaluated. Gouts with positive DECT results in early, middle, and late stages were 78.5 %, 81.4 %, and 95.8 %, respectively (all P > .05). The total and ankle/midfoot DECT scores at different stages significantly increased with disease duration (all P < .05). DECT scores of 4 regions excluding the first metatarsophalangeal joint in early and middle stages were lower than those in late stage (all P < .05). DECT scores achieved excellent diagnostic performance for differentiating gout in early stage from middle and late stages (area under the curve, 0.923 and 0.949), with high sensitivity, specificity, positive predictive value, and negative predictive value (all > 85 %). Total DECT score was highly positively correlated with the volume of urate crystals (R = 0.873, P < .001). Disease duration, serum uric acid level, bone erosion, and Achilles tendon involvement significantly affected total DECT scores (all P < .01). In conclusion, longer disease duration, higher serum uric acid levels, bone erosion, and Achilles tendon involvement were closely associated with total DECT scores. DECT scoring system may be an invaluable tool for gout diagnosis owing to its high detection efficacy and a surrogate method to evaluate the amount of urate crystals and erosion of surrounding tissues.
... Similarly, the study of Svensson et al. on 55 patients with new or established gout, as well as the study of Dalbeth et al. on 152 gout patients treated with allopurinol also revealed an association between positive DECT with bone erosion and presence of tophi. 19,20 However, in the latter study, UA concentration was >35.69 mmol/L, which was much higher than the concentration estimated in our study. ...
Background:
Gout is caused by deposition of monosodium urate (MSU) crystals. One of the tools of choice to identify MSU crystals is the Dual-Energy Computed Tomography (DECT). This study aims to determine MSU crystal deposition using DECT by comparing its detection in the first metatarsophalangeal joints (MTPJ) with that in the ankles, as well as to analyse the association between the crystal deposition and anthropometrics, clinical characteristics, and serum biochemical levels of a primary gout patient.
Materials and methods:
This cross-sectional study included patients (n = 94) from the Clinic Hoa Hao Medic Medical Centre in Vietnam, who were diagnosed with primary gout with pain/swelling of at least one ankle or first MTPJ. DECT of both joints was used to identify MSU. Statistical analyses were performed using the Student's t-test, Wilcoxon ranksum, Pearson's chi-square, and Spearman's tests.
Results:
Approximately 80% had MSU crystal deposition in the ankle and/or first MTPJ with no significant difference in deposition between the two joints. MSU deposition was significantly associated with disease duration (p = 0.003), flare-ups (p = 0.006), and cut-off of 6 weeks' duration (p = 0.006), bone erosion (p = 0.006), and palpable tophi (p = 0.003). There was no association between MSU deposition with age, body mass index (BMI), hypertension, serum levels of uric acid (UA), creatinine, high-sensitive C-reactive protein (hsCRP), total cholesterol (C-total), and triglyceride (TG).
Conclusions:
MSU deposition occurred in both ankle and first MTP at the same rate. The deposition was associated with disease duration and flare-ups. Prevention of flare-ups seems helpful to limit MSU crystal deposition.
... This may be due to the fact that the sensitivity of CT is higher than that of ultrasound [16]. To our knowledge, studies have examined the validity of DECT in gout and the good correlations with clinical characteristics [17]. ...
Objective
This study aimed to assess the factors influencing bone erosion in patients with gout using dual-energy gemstone spectral imaging CT.
Methods
We compared the clinical data, laboratory indices, and tissue urate levels at the monosodium urate (MSU)-bone interface measured by dual-energy gemstone spectral imaging computed tomography of 87 gout patients with (n=41) and without (n=46) bone erosion. Logistic regression analysis was used to investigate the risk factors associated with bone erosion.
Results
In total, 47.1% of patients with gout had bone erosion. The disease duration, serum uric acid, tissue urate levels, and the presence of tophi were significantly higher (p<0.05) in gout patients with bone erosion than in those without bone erosion. Longer disease duration (OR=1.11, 95% CI: 1.00–1.24, p<0.05) and increased tissue urate levels (OR=1.01, 95% CI: 1.00–1.02, p<0.05) were independently associated with bone erosion. Tissue urate levels at the MSU-bone interface were correlated with the presence of tophi (r=0.62, p<0.001), bone erosion (r=0.51, p<0.001), renal calculus (r=0.24, p=0.03), and serum uric acid levels (r=0.23, p=0.03).
Conclusion
This study found that longer disease duration and elevated tissue urate concentrations at the MSU-bone interface were associated with bone erosion in patients with gout.
... Furthermore, the results of our study also showed that the total urate deposit score was higher in patients with longer disease duration and correlated strongly to the presence of tophus, bone erosion, and disease duration. Similarly, Svensson et al. [31] applied this urate scoring method and found that the amount of MSU deposits is associated with the presence of tophus and disease duration. Dalbeth et al. [26] found that higher urate deposits are correlated with tophi and bone erosion. ...
Objectives
To investigate the diagnostic performance of single-source dual-energy computed tomography (DECT) based on gemstone spectral imaging technology (including Discovery CT750HD and Revolution CT) in patients with suspected feet/ankles gouty arthritis, and evaluate the urate deposition with a novel semi-quantitative DECT scoring system.
Methods
A total of 196 patients were consecutively included. Feet and ankles were evaluated in all patients by single-source DECT scan. The 2015 EULAR/ACR criteria were used as the reference for the diagnosis of gout. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of DECT for the diagnosis of gout in the early (≤1 year), middle (1–3 years), and late (> 3 years) disease durations were calculated. Besides, a novel semi-quantitative DECT scoring system was assessed for the measurement of urate deposition, and the correlation between the scores and the clinical and serological data were also evaluated. Moreover, the influences of artifacts on the diagnostic performance of DECT were also determined.
Results
The sensitivity, specificity, and AUC of DECT in 196 patients were 38.10, 96.43%, and 0.673 in the early-stage group; 62.96, 100.00%, and 0.815 in the middle-stage group; and 77.55, 87.50%, and 0.825 in the late-stage group, respectively. The overall diagnostic accuracies in the AUC of DECT (Discovery CT750HD and Revolution CT) in the middle and late stages of gout were higher than that in the early stage of gout. Besides, the monosodium urate crystals were deposited on the first metatarsophalangeal joints and ankles/midfeet. Age, the presence of tophus, bone erosion, and disease duration considerably affected the total urate score. No statistical difference in the positive detection of nail artifact, skin artifact, vascular calcification, and noise artifact was found between the case and control groups.
Conclusion
DECT (Discovery CT750HD and Revolution CT) showed promising diagnostic accuracy for the detection of urate crystal deposition in gout but had limited diagnostic sensitivity for short-stage gout. Longer disease duration, the presence of tophus, and bone erosion were associated with the urate crystal score system. The artifacts do not remarkably affect the diagnostic performance of DECT in gout.
... One limitation of our study is that the DECT scoring was performed by only one reader, but this this reader is an experienced radiologist who scored all images. Prior work has demonstrated good intra-reader agreement using the DECT scoring system [20]. Further, the lack of a control group does not allow causal inferences. ...
Objectives
There is a lack of large longitudinal studies of urate deposition measured by dual-energy computed tomography (DECT) during urate lowering therapy (ULT) in people with gout. We explored longitudinal changes in DECT urate depositions during a treat-to-target strategy with ULT in gout.
Methods
Patients with a recent gout flare and serum-urate (sUA) >360 µmol/l attended tight-control visits during escalating ULT. The treatment target was sUA <360 µmol/l, and <300 µmol/l if presence of tophi.
A DECT scanner (General Electric Discovery CT750 HD) acquired data from bilateral forefeet and ankles at baseline and after one and two years. Images were scored in known order, using the semi-quantitative Bayat method, by one experienced radiologist who was blinded to serum urate and clinical data. Four regions were scored: the first metatarsophalangeal (MTP1) joint, the other joints of the toes, the ankles and midfeet, and all tendons in the feet and ankles.
Results
DECT was measured at baseline in 187 of 211 patients. The mean (S.D.) serum urate level (μmol/l) decreased from 501 (80) at baseline to 311 (48) at 12 months, and 322 (67) at 24 months.
DECT scores at all locations decreased during both the first and the second year (p< 0.001 for all comparisons vs baseline), both for patients achieving and not achieving the sUA treatment target.
Conclusions
In patients with gout, urate depositions in ankles and feet as measured by DECT decreased both in the first and the second year, when patients were treated using a treat-to-target ULT strategy.
Purpose of the review:
Dual energy computed tomography (DECT) scan has emerged as a useful diagnostic tool in the diagnosis of gout over recent years. Here, we review the role of DECT in the context of typical and atypical gout, including its role in identifying extra-articular monosodium urate (MSU) deposition.
Recent findings:
DECT has been found to be more accurate than ultrasound in detecting extra-articular MSU deposition in soft tissue. It has the ability to identify axial MSU deposition in gout patients with non-specific back pain. For individuals with no other clear etiology, this potentially implicates MSU as the cause of the pain. DECT also has the ability to detect vascular MSU deposition. This correlates with high coronary calcium scores and elevated Framingham cardiovascular risk. DECT continues to aid our understanding of articular and extra-articular MSU deposition, including the role of vascular MSU deposition on cardiovascular health. Not only does it allow quantification of urate burden but it can also potentially avoid invasive diagnostic procedures. The limitations and advantages of DECT are further explored in this article.
