title: The application of dual-energy computed tomography in the diagnosis of acute gouty arthritis.
abstract: The aim of the study was to investigate the sensitivity and specificity of dual-energy computed tomography in the diagnosis of acute gouty arthritis, and the related risk factors for urate crystal deposition. One hundred ninety-one patients (143 with acute gouty arthritis and 48 with other arthritic conditions) were studied. All patients had acute arthritic attack in the recent 15 days and underwent dual-energy computed tomography (DECT) scan with the affected joints. The urate volume was calculated by DECT and the basic information of these patients was recorded at the same time. Uric acid crystals were identified with DECT in 140 of 143 (97.9 %) gout patients and 6 of 48 (12.5 %) of nongout patients, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of DECT in the diagnosis of acute gouty arthritis were 97.9, 87.5, 95.9, and 93.3 %, respectively. The urate volumes were ranged from 0.57 to 54,543.27 mm(3) with a mean volume of 1,787.81 ± 7,181.54 mm(3). Interestingly, urate volume was correlated with the disease duration, serum uric acid levels, the presence of tophi, and bone erosion. Two-year follow-up data was available in one patient with recurrent gouty arthritis, whose urate volume was gradually reduced in size by DECT detection after urate-lowering therapies. DECT showed high sensitivity and specificity for the identification of urate crystals and diagnosis of acute gout. The risk factors for uric acid deposition include the disease duration, serum uric acid levels, the presence of tophi, and bone erosion. DECT has an important role in the differential diagnosis of arthritis, and also could be served as a follow-up tool.
authors.affiliation: Department of Rheumatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Huaxiang
authors.initials: H
authors.lastname: Wu
authors.forename: Jing
authors.initials: J
authors.lastname: Xue
authors.forename: Lu
authors.initials: L
authors.lastname: Ye
authors.forename: Qijing
authors.initials: Q
authors.lastname: Zhou
authors.forename: Dan
authors.initials: D
authors.lastname: Shi
authors.forename: Rongzhen
authors.initials: R
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015210:Arthritis, Gouty / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033461:Hyperuricemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014527:Uric Acid / Q000032:analysis / Q000097:blood; D055815:Young Adult
chemical_list: D014527:Uric Acid
references.citation: Clin Rheumatol. 2013 Feb;32(2):225-32
references.pmid: 23138881
references.citation: Arthritis Rheum. 1977 Apr;20(3):895-900
references.pmid: 856219
references.citation: J Clin Rheumatol. 2012 Jan;18(1):23-7
references.pmid: 22157268
references.citation: Curr Rheumatol Rep. 2013 Jan;15(1):301
references.pmid: 23292817
references.citation: Rheumatol Int. 2012 Jan;32(1):235-9
references.pmid: 20016988
references.citation: Rheumatology (Oxford). 2013 Feb;52(2):402-3
references.pmid: 23211333
references.citation: Arthritis Rheum. 2011 Oct;63(10):3136-41
references.pmid: 21800283
references.citation: Ann Rheum Dis. 2013 Sep 1;72(9):1545-8
references.pmid: 23334212
references.citation: Cardiol Rev. 2011 Nov-Dec;19(6):265-71
references.pmid: 21983313
references.citation: Ann Rheum Dis. 2012 Mar;71(3):470-2
references.pmid: 21859688
references.citation: Arthritis Rheum. 2012 Apr;64(4):1290
references.pmid: 22139883
references.citation: Arthritis Res Ther. 2011;13(6):246
references.pmid: 22085684
references.citation: Ann Rheum Dis. 2009 Oct;68(10):1609-12
references.pmid: 19066180
references.citation: Ann Rheum Dis. 2012 Sep;71(9):1466-71
references.pmid: 22387729
references.citation: Radiology. 2011 Nov;261(2):516-24
references.pmid: 21926378
references.citation: AJR Am J Roentgenol. 2010 Apr;194(4):1072-8
references.pmid: 20308513
references.citation: Postgrad Med. 2013 Jan;125(1):106-14
references.pmid: 23391676
references.citation: Ann Rheum Dis. 2009 Aug;68(8):1290-5
references.pmid: 18708415
references.citation: J Clin Rheumatol. 2009 Feb;15(1):22-4
references.pmid: 19125136
references.citation: Radiographics. 2011 Sep-Oct;31(5):1365-75; discussion 1376-7
references.pmid: 21918049