Clinical utility of Dual Energy Computed Tomography in gout: current concepts and applications

Abstract

Gout is the most common inflammatory arthritis and is increasing in prevalence and incidence in many countries worldwide. Dual Energy Computed Tomography (DECT) has a high diagnostic accuracy in established gout, but its diagnostic sensitivity is low in subjects with recent-onset gout. A meta-analysis of 17 studies showed a pooled sensitivity and specificity of 0.85 and 0.88, respectively. DECT is a useful diagnostic tool for patients with contraindications for joint aspiration or for those who refuse joint aspiration. This article aims to give an up to date review and summary of existing literature on the role and accuracy of DECT in the imaging of gout.

Figure 1.

Dual-energy CT. A-B: sagittal multiplanar reformatted grayscale images of ankles/feet showing large bone erosions and severe joint damage at the tarso-metatarsal joints of both feet, with high-attenuating material adjacent to the erosions and along the distal end of the right Achilles tendon (A) representing monosodium urate deposition. C: corresponding volume-rendered color-coded dual-energy image of ankles/feet showing urate deposits (depicted in green) at the tarsometatarsal, metatarsophalangeal and interphalangeal joints and along the distal end of the right Achilles tendon. Automated quantification of urate volume is displayed at the top of the image.

Figure 2.

Sensitivity (A) and specificity (B) estimates for dual-energy computed tomography for the diagnosis of gout. Circles and lines represent point estimates and 95% confidence intervals, respectively.

Figure 3.

Dual-energy CT. A: coronal multiplanar reformatted grayscale images of hands/wrists showing bone erosions at left wrist and fingers of both hands, with high-attenuating material adjacent to the erosions and along the metacarpophalangeal and proximal and distal interphalangeal joints, indicative of monosodium urate deposits. B: corresponding volume-rendered color-coded dual-energy image of wrists/hands showing numerous urate deposits (depicted in green) along the metacarpophalangeal and proximal and distal interphalangeal joints and in the both wrists. Bilateral dislocation of first metacarpophalangeal joints can also be observed. Automated quantification of urate volume is displayed at the top of the image.

Figure 4.

Dual-energy CT. Volume-rendered color-coded dual-energy image of ankles/feet showing urate deposits (depicted in green). Automated quantification of urate volume is displayed at the top of the image.