Rationale and Objectives
Dual-energy computed tomography (DECT) and ultrasound are both used to assess gouty arthritis. The present study was designed to compare the diagnostic accuracy of DECT and ultrasound in detecting monosodium urate (MSU) crystal deposition in various joints.
Materials and Methods
This study enrolled 40 patients diagnosed with acute gouty arthritis. All affected and contralateral joints were scanned (128 in total) using both DECT and ultrasound to determine the MSU deposition in upper limbs (wrist and elbow) and lower limbs (the first metatarsophalangeal joints, ankles, and knee). The MSU crystal accumulation detected by each method was compared for various joints.
Results
The 128 scanned joints included 52 of the upper limbs and 76 of the lower limbs. For the upper limbs, the percentage of MSU crystal accumulation detected by DECT (22/52, 42.3%) was significantly higher than that by ultrasound (10/52, 19.2%; P = .0027). The detection rates of the two methods for the lower limbs were similar ( P = .3173).
Conclusions
For detection of MSU crystal deposition in the upper limb joints, DECT was superior to ultrasound, whereas there was no difference between the two methods for the lower limbs. Therefore, ultrasound can be used for primary screening, and DECT afterward. Although the modalities are similar in making the initial diagnosis, DECT is far superior at displaying the anatomic extent of the disease.
Gouty arthritis (gout) is a form of inflammatory arthritis, most prevalent among middle-aged to elderly men and postmenopausal women. It is characterized by abnormal purine metabolism, hyperuricemia, and subsequent abnormal deposition of monosodium urate (MSU) crystals . The incidence of gout is increasing; the number of cases increased by approximately two per 1000 during the 10-year period between 1990 and 1999 . The disease affects about 3.9% of the population in the United States and 1.4% of the population in the United Kingdom and Germany . Although the prevalence is relatively low in China (reportedly 1.14%) , the country still suffers a significant disease burden because of its large population.
The pathogenesis of gout remains to be elucidated. Long-term deposition of MSU crystals in the joints leads to damage to articular cartilage and bone and may result in organ dysfunction, especially renal impairment and cardiac diseases . Clinical outcomes can be severe, limiting daily activity and impairing the quality of life of gout patients.
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Materials and methods
Patients
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Dual-energy computed tomography
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Ultrasound
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Statistical analysis
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Results
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Table 1
Demographic and Clinical Characteristics of Forty patients ∗
Age, y 58.5; 53–68 Men, n (%) 38 (95.0) Women, n (%) 2 (5.0) Disease duration, y 6.5; 4.5–8.5 Monosodium urate crystal deposition in synovial fluid, n (%) 6 (15) Macroscopic tophi, n (%) 13 (32.5) Acute attack duration, d 4.0; 2.5–6.5 d Screening serum uric acid, mmol/L 530; 485–570
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Table 2
Comparison of DECT to Ultrasound for Detecting MSU in Scanned Joints
Scanned Joints Ultrasound DECT + − Total All + 47 17 64 − 3 61 64 Total 50 78 128 Upper limbs ∗ + 8 14 22 − 2 28 30 Total 10 42 52 Lower limbs † + 39 3 42 − 1 33 34 Total 40 36 76
DECT, dual-energy computed tomography; MSU, monosodium urate.
+ (−): Positive (negative) for MSU crystal deposition.
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Table 3
Comparison of DECT to Ultrasound for Detecting MSU in the Contralateral Joints
Ultrasound DECT + − Total + 22 4 26 − 0 56 56 Total 22 60 82
DECT, dual-energy computed tomography; MSU, monosodium urate.
+ (−): Positive (negative) for MSU crystal deposition.
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Discussion
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Conclusions
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