title: Dual-energy computed tomography as a diagnostic tool for gout during intercritical periods.
abstract: OBJECTIVE
  The aim of this study is to evaluate the diagnostic yield of dual-energy computed tomography (DECT) in detection of uric acid accumulation in joints or periarticular structures in patients suspected of having gout, in their intercritical period.
  
  
  METHODS
  Patients with a history of recurrent, short-lived mono- or oligo-arthralgia or arthritis, referred to the rheumatology clinic for diagnosis of their condition, were included in this retrospective evaluation.
  
  
  RESULTS
  DECT confirmed the diagnosis of gout in 30 of 50 patients (60%). A positive DECT was present in 12 of 16 cases (75%) with serum uric acid > 8.5 mg/dL, compared to seven of 13 cases (54%) and two of five cases (40%) with levels of 6.1-8.5 mg/dL and ≤ 6 mg/dL, respectively. The diagnostic impact of screening hands and feet were highest (78% and 56%, respectively). Follow-up data were available for 24 of the 30 patients with urate deposits identified by DECT. Twenty-one were treated with urate-lowering agents, all responded with lowering of serum uric acid and cessation of flares. Follow-up data were available for 16 of the 20 patients with no urate deposits identified by DECT. Gout was diagnosed in two of them by synovial fluid examination during subsequent flares. Both positive and negative predictive values of DECT for diagnosing gout in this patient population were 87%. Following DECT, treatment regimen was modified to gout-specific therapy in 52% of the patients.
  
  
  CONCLUSIONS
  The ability to make a definite diagnosis of gout by DECT imaging in a substantial number of asymptomatic patients in the intercritical period should help in treatment decision-making and improve patient adherence to long-term urate-lowering therapy.
authors.affiliation: Rheumatology Unit, Department of Medicine, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Breuer
authors.affiliation: Department of Radiology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
authors.forename: Naama
authors.initials: N
authors.lastname: Bogot
authors.affiliation: Rheumatology Unit, Department of Medicine, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
authors.forename: Gideon
authors.initials: G
authors.lastname: Nesher
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D005260:Female; D006073:Gout / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000378:metabolism; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D007596:Joints / Q000737:chemistry / Q000000981:diagnostic imaging* / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D015415:Biomarkers; D006074:Gout Suppressants; D014527:Uric Acid
keywords: DECT; dual-energy computed tomography; gout; intercritical