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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.
Meth...
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Context 1
... presence of tophus, bone erosion, and disease duration significantly affected the total urate score (P < 0.050), whereas gender, SUA level at time DECT, uratelowering treatments, BMI, time from last gouty attack to DECT exam, and renal function did not significantly affect the total urate score (P > 0.050, Table 4). ...Similar publications
Background:Acute gouty arthritis (GA) is the main clinical manifestation and the most common initial symptom of gout. The treatment of acute GA involves the use of colchicine, non-steroidal anti-inflammatory drugs, and corticosteroids. Because of the side effects of these drugs, their clinical application is limited.The use oftraditional Chinese me...
Citations
... С другой стороны, в исследовании J. Shang и соавт. [46] не было выявлено значимой связи между наличием почечной недостаточности и объёмом депозитов моноурата натрия на ДЭКТ. ...
... В работе J. Shang и соавт. [46], где использовался полуколичественный метод «DECT urate scoring system», корреляции между балльной оценкой и концентрацией мочевой кислоты в сыворотке крови обнаружено не было, однако была подтверждена связь между количеством моноурата натрия в тканях и длительным периодом заболевания, наличием эрозий и тофусов. Причиной несоответствия между результатами ДЭКТ и уровнем мочевой кислоты может являться и время проведённого исследования. ...
The importance of dual-energy computed tomography in the diagnosis of gout, the principles of dual-energy computed tomography, the accuracy of the methodology, and the types of artifacts are discussed in this study. The possible dependence of the presence of deposits of sodium monourate on other clinical data and the role of dual-energy computed tomography in the differential diagnosis of other crystalline arthropathies are considered.
The dual-energy computed tomography has several advantages, including noninvasiveness, speed of execution, and a significant reduction in the risk of iatrogenic consequences compared with diagnostic arthrocentesis, which is the gold standard in diagnosing gout. Dual-energy computed tomography can accomplish gout detection, treatment, and differential diagnosis.
... Bone erosion is a strong predictor of musculoskeletal disability in gout (15); therefore, early detection and assessment are critical in reducing the risk of joint functional disability. Over the past decade, radiology has been used to investigate the relationship between MSU crystals and bone erosion (16)(17)(18)(19). Jin et al. (18) employed a novel semi-quantitative DECT scoring system to assess urate deposition (UD) and demonstrate that total urate was associated with bone erosion. ...
... Over the past decade, radiology has been used to investigate the relationship between MSU crystals and bone erosion (16)(17)(18)(19). Jin et al. (18) employed a novel semi-quantitative DECT scoring system to assess urate deposition (UD) and demonstrate that total urate was associated with bone erosion. Mark et al. (16) utilized a plain radiographerosion score and urate volume from DECT to demonstrate that tophus urate was directly associated with erosion. ...
... In this study, the volume of MSU crystals measured from DECT images was strongly and positively associated with the degree of bone erosion, which is consistent with the results of previous studies. Jin et al. (18) people with erosive gout and that MSU crystals reduce osteocyte viability through direct interactions (21)(22)(23). Additionally, cells within and around the tophus produce cytokines, chemokines, enzymes, and other mediators that foster an inflammatory environment conductive to bone and joint damage (3). ...
Objective
This study aimed to analyze the effect of urate deposition (UD) on bone erosion and examine the association between the volume of monosodium urate (MSU) crystals and an improved bone erosion score method, as measured in the metatarsophalangeal (MTP) joints of patients with gout.
Materials and methods
Fifty-six patients diagnosed with gout using the 2015 European League Against Rheumatism and American College of Rheumatology criteria were enrolled. MSU crystals volume at each MTP joint was measured using dual-energy computed tomography (DECT) images. The degree of bone erosion was evaluated with the modified Sharp/van der Heijde (SvdH) erosion scoring system based on CT images. Differences in clinical features between patients with (UD group) and without (non-UD group) UD were assessed, and the correlation between erosion scores and urate crystal volume was analyzed.
Results
The UD and non-UD groups comprised 30 and 26 patients, respectively. Among the 560 MTP joints assessed, 80 showed MSU crystal deposition, and 108 showed bone erosion. Bone erosion occurred in both groups but was significantly less severe in the non-UD group ( p < 0.001). Both groups had equivalent levels of serum uric acid ( p =0.200). Symptom duration was significantly longer in the UD group ( p =0.009). The UD group also had a higher rate of kidney stones ( p =0.023). The volume of MSU crystals was strongly and positively associated with the degree of bone erosion (r=0.714, p < 0.001).
Conclusion
This study found that patients with UD show significant increased bone erosion than those without UD. The volume of MSU crystals is associated with the improved SvdH erosion score based on CT images, regardless of serum uric acid level, demonstrating the potential of combining DECT and serum uric acid measurements in helping optimize the management of patients with gout.
... While DECT has been increasingly used in the detection and volume assessment of MSU crystals in patients with gout, only 2 studies have applied this scoring system to evaluate urate deposition in these patients. [15] In current study, we analyzed the total and 4 regions DECT scores of ankle/foot in different stages gout, to investigate the following hypothesis that this semi-quantitative DECT urate scoring system can evaluate MSU crystal deposition in the feet and ankles of patients with gout during different stages. ...
... [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. [15,19] The results of this present study are consistent with these findings. Furthermore, this present study demonstrated that longer disease duration and bone erosion were strongly associated with higher total DECT urate scores. ...
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.
... and a specificity 0.88 (95% CI 0.84-0.99). 32 DECT reliability was not influenced by gout duration, with interreader agreements of 0.87 and 0.86 in early gout and late gout, respectively. 32 In a separate study, Shang et al 18 performed a metaanalysis of 28 studies with DECT and ultrasound, including early gout, defined as disease duration of less than 2 years. ...
... 32 DECT reliability was not influenced by gout duration, with interreader agreements of 0.87 and 0.86 in early gout and late gout, respectively. 32 In a separate study, Shang et al 18 performed a metaanalysis of 28 studies with DECT and ultrasound, including early gout, defined as disease duration of less than 2 years. The DECT pooled sensitivity in early gout was 0.75 (95% CI 0.60-0.86) ...
Objective
This Systematic Literature Review determined whether there is clinical utility for Dual Energy CT (DECT) to inform on prognosis for gout patients. With DECT, individualized treatment plans could be developed based on the patient's unique urate burden, with DECT used as a clinical outcome measure in gout management.
Methods
To evaluate DECT as a reliable, valid, and sensitive prognostic instrument, a librarian-assisted search was undertaken in PubMed and EMBASE for articles on gout and DECT informing on reliability, validity (content, construct, criterion), sensitivity to change and minimum clinically important changes.
Results
This systematic literature review showed that DECT has high intra- and inter-rater reliability. Tophus burden correlates with functional loss to show content validity. DECT volume is positively correlated with death and cardiovascular risk factors, and the risk for future gout flares. DECT has excellent sensitivity to change with effective urate lowering therapies.
Conclusion
DECT is a promising prognostic tool based on its high reliability, sensitivity to change, and emerging validity. Additional large, well-designed prospective cohort studies are needed to fully evaluate its prognostic utility. This systematic review suggests it's very likely DECT has additional prognostic information beyond clinical tophi assessment alone.
... However, in early disease (symptom duration <1 or 2 years), DECT sensitivity may be insufficient, owing to a spatial resolution of several hundred microns at best, precluding detection of small deposits. A recent cohort study of 196 patients compared the diagnostic performance of DECT alone according to disease duration [14]. DECT demonstrated poor sensitivity (38%) in very early disease (<1 year), a situation where ultrasound usually displays better performance. ...
... To sum up, we may not yet be in the 'fully known' section but DECT seems to perform better than ultrasound in terms of diagnosis, particularly for the ankles and feet (results are more uneven for the upper limbs), except for very early disease where false-negative DECT is frequent (whereas the ultrasound double contour sign has better chances of being positive) [10,14]. ...
Purpose of review:
To give an overview of what can reasonably be considered as known about dual-energy computed tomography (DECT) in crystal-related arthropathies, and what still needs to be explored.
Recent findings:
Recent studies suggest an overall superiority of DECT over ultrasound in gout in terms of sensitivity (89 vs. 84%) and specificity (91 vs. 84%), except in early disease. Additional studies are needed to optimize DECT postprocessing settings in order to improve the specificity of the technique and eliminate all artifacts. Evidence has been controversial concerning DECT's ability to detect monosodium urate (MSU) crystal deposits on vessel walls, or whether or not MSU-coded plaques are artifacts. DECT can be used to monitor MSU crystal depletion during urate-lowering treatment; MSU crystal volume is associated with cardiovascular risk and disease activity. There are some reports on calcium-containing crystal deposition diseases (calcium pyrophosphate and basic calcium phosphate) demonstrating that DECT can characterize and discriminate between the different types of crystals.
Summary:
Our knowledge about the use of DECT in crystal-related arthropathies continues to expand. Some unknowns have been clarified but there's still lots to learn, particularly concerning gout management and the potential use of DECT in calcium-containing crystal-related arthropathies.
... The lower-limb joints, especially the first metatarsophalangeal joint, are the most affected region. [9][10][11] Normally, an acute gout attack is self-limiting and resolves spontaneously in a few days. 12 However, as the disease progresses, tophi-masses of MSU crystals embedded in chronic granulomatous and inflammatory tissues (namely, giant cells and osteoclasts)-can cause chronic joint damage, resulting in severe synovitis, cartilage destruction, and bony erosions. ...
Gouty arthritis (GA), one of the most common forms of inflammatory arthritis, is characterized by elevated serum uric acid concentrations and the consequent deposition of monosodium urate crystals. Under low-grade inflammatory stress, cells tend to adapt to the microenvironment by reprogramming their metabolic pathways. Here we review the aberrant metabolic responses to the inflammatory environment in immune and tissue cells in distinct phases of GA. Regulation of these pathways is implicated in metabolic alterations including mitochondrial dysfunction, changes in the glycolytic pathway, and alteration of lipid, uric acid, and bone metabolism among others. Investigations of how these alterations lead to proinflammatory and anti-inflammatory effects in each period of GA have revealed links to its pathogenesis. Knowledge gained may open up new opportunities for diagnosis, treatment and prognosis of GA and offer rationale for further investigation into the mechanisms underlying the progression of the disease.
Objective
This study investigates the MRI features of knee gouty arthritis (KGA), examines its relationship with the extent of tissue involvement, and assesses whether risk factors can predict KGA.
Materials and methods
Patients diagnosed with KGA underwent MRI examinations, and two independent observers retrospectively analyzed data from 44 patients (49 knees). These patients were divided into mild and severe groups based on tissue involvement observed during arthroscopy. MRI features were summarized, and the intraclass correlation coefficient evaluated interobserver reproducibility. Single-factor analysis compared clinical indicators and MRI features between groups, while Cramer's V coefficient assessed correlations. Multivariate logistic regression identified predictors of tissue involvement extent, and a ROC curve evaluated diagnostic performance.
Results
Among 49 knees, 18 had mild and 31 had severe tissue involvement. Key MRI features included ligament sketch-like changes, meniscal urate deposition, irregularly serrated cartilage changes, low-signal signs within joint effusion, synovial proliferation, Hoffa's fat pad synovitis, gouty tophi, bone erosion, and bone marrow edema. The interobserver reliability of the MRI features was good. Significant differences (P < 0.05) were observed between the groups for anterior cruciate ligament (ACL) sketch-like changes, Hoffa's fat pad synovitis, and gouty tophi. ACL sketch-like changes (r = 0.309), Hoffa's fat pad synovitis (r = 0.309), and gouty tophi (r = 0.408) were positively correlated with the extent of tissue involvement (P < 0.05). ACL sketch-like changes (OR = 9.019, 95 % CI: 1.364–61.880), Hoffa's fat pad synovitis (OR = 6.472, 95 % CI: 1.041–40.229), and gouty tophi (OR = 5.972, 95 % CI: 1.218–29.276) were identified as independent predictors of tissue involvement extent (P < 0.05). The area under the ROC curve was 0.862, with a sensitivity of 67.70 %, specificity of 94.40 %, and accuracy of 79.14 %.
Conclusion
This comprehensive analysis of MRI features identifies ligament sketch-like changes, meniscal urate deposition, and low-signal signs within joint effusion as characteristic MRI manifestations of KGA. Irregular cartilage changes are valuable for differential diagnosis in young and middle-aged patients. ACL sketch-like changes, Hoffa's fat pad synovitis, and gouty tophi correlate with tissue involvement severity and are critical in predicting and assessing the extent of tissue involvement in KGA.
The knee is one of the most commonly affected joints in the course of inflammatory arthropathies, such as crystal-induced and autoimmune inflammatory arthritis. The latter group includes systemic connective tissue diseases and spondyloarthropathies. The different pathogenesis of these entities results in their varied radiologic images. Some lead quickly to joint destruction, others only after many years, and in the remaining, destruction will not be a distinguishing radiologic feature.
Radiography, ultrasonography, and magnetic resonance imaging have traditionally been the primary modalities in the diagnosis of noninflammatory and inflammatory arthropathies. In the case of crystallopathies, dual-energy computed tomography has been introduced. Hybrid techniques also offer new diagnostic opportunities. In this article, we discuss the pathologic findings and imaging correlations for crystallopathies and inflammatory diseases of the knee, with an emphasis on recent advances in their imaging diagnosis.
Objective
To summarise current data regarding the use of imaging in crystal-induced arthropathies (CiAs) informing a European Alliance of Associations for Rheumatology task force.
Methods
We performed four systematic searches in Embase, Medline and Central on imaging for diagnosis, monitoring, prediction of disease severity/treatment response, guiding procedures and patient education in gout, calcium pyrophosphate dihydrate deposition (CPPD) and basic calcium phosphate deposition (BCPD). Records were screened, manuscripts reviewed and data of the included studies extracted. The risk of bias was assessed by validated instruments.
Results
For gout, 88 studies were included. Diagnostic studies reported good to excellent sensitivity and specificity of dual-energy CT (DECT) and ultrasound (US), high specificity and lower sensitivity for conventional radiographs (CR) and CT. Longitudinal studies demonstrated sensitivity to change with regard to crystal deposition by US and DECT and inflammation by US and structural progression by CR and CT. For CPPD, 50 studies were included. Diagnostic studies on CR and US showed high specificity and variable sensitivity. There was a single study on monitoring, while nine assessed the prediction in CPPD. For BCPD, 56 studies were included. There were two diagnostic studies, while monitoring by CR and US was assessed in 43 studies, showing a reduction in crystal deposition. A total of 12 studies with inconsistent results assessed the prediction of treatment response. The search on patient education retrieved two studies, suggesting a potential role of DECT.
Conclusion
This SLR confirmed a relevant and increasing role of imaging in the field of CiAs.
