title: Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT.
abstract: OBJECTIVE
  To determine the diagnostic and therapeutic impact of dual-energy computed tomography (DECT) in gout.
  
  
  METHODS
  Forty-three patients with (n = 20) and without a history of gout (n = 23) showing non-specific soft tissue deposits underwent DECT after unrewarding arthrocentesis. Two blinded, independent readers evaluated DECT for the presence of urate crystals. Clinical diagnosis, clinically suspected urate crystal locations, diagnostic thinking and therapeutic decisions were noted before and after DECT. Clinical 1-month follow-up was obtained.
  
  
  RESULTS
  DECT showed urate in 26/43 patients (60 %). After DECT, clinical diagnosis of gout was withdrawn in 17/43 (40 %) and was maintained in 16/43 patients (37 %). In 10/43 patients (23 %) the diagnosis was maintained, but DECT revealed urate in clinically unsuspected locations. In 23/43 patients (53 %), a treatment-change based on DECT occurred. Changes in diagnostic thinking occurred more frequently in patients without a history of gout (p < 0.001), changes in therapeutic decisions more frequently in patients with a history of gout (p = 0.014). Clinical follow-up indicated beneficial effects of DECT-based diagnoses in 83 % of patients.
  
  
  CONCLUSIONS
  In patients with or without a history of gout and a recent suspicion for gouty arthritis with an unrewarding arthrocentesis, DECT has a marked diagnostic and therapeutic impact when hyperdense soft-tissue deposits are present.
  
  
  CONCLUSIONS
  • This study evaluates the concept of evidence-based radiology • In patients with suspected gout, DECT can help clinicians make the diagnosis • DECT has a marked impact on therapy • Clinical follow-up after 1 month indicated reliable results of DECT.
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors: Tim
authors: T
authors: Finkenstaedt
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors: Andrei
authors: A
authors: Manoliou
authors: Department of Rheumatology, University Hospital Zurich and University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
authors: Martin
authors: M
authors: Toniolo
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors: Kai
authors: K
authors: Higashigaito
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors: Gustav
authors: G
authors: Andreisek
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors: Roman
authors: R
authors: Guggenberger
authors: Department of Rheumatology, University Hospital Zurich and University of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
authors: Beat
authors: B
authors: Michel
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. hatem.alkadhi@usz.ch.
authors: Hatem
authors: H
authors: Alkadhi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015210:Arthritis, Gouty / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014527:Uric Acid
chemical_list: D014527:Uric Acid
keywords: Dual-energy computed tomography; Evidence-based radiology; Gout; Gouty arthritis; Urate