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. 2022 Sep 1;57(9):613-619.
doi: 10.1097/RLI.0000000000000879. Epub 2022 Apr 21.

Assessing the Sensitivity of Dual-Energy Computed Tomography 3-Material Decomposition for the Detection of Gout

Justin J Tse, Douglas A Kondro  1 , Michael T Kuczynski, Yves Pauchard  2 , Andrea Veljkovic, David W Holdsworth  3 , Viviane Frasson  4 , Sarah L Manske, Paul MacMullan  5 , Peter Salat
Affiliations

Assessing the Sensitivity of Dual-Energy Computed Tomography 3-Material Decomposition for the Detection of Gout

Justin J Tse et al. Invest Radiol. .

Abstract

Objectives: The aim of this study was to assess the accuracy and precision of a novel application of 3-material decomposition (3MD) with virtual monochromatic images (VMIs) in the dual-energy computed tomography (DECT) assessment of monosodium urate (MSU) and hydroxyapatite (HA) phantoms compared with a commercial 2-material decomposition (2MD) and dual-thresholding (DT) material decomposition methods.

Materials and methods: Monosodium urate (0.0, 3.4, 13.3, 28.3, and 65.2 mg/dL tubes) and HA (100, 400, and 800 mg/cm 3 tubes) phantoms were DECT scanned individually and together in the presence of the foot and ankle of 15 subjects. The raw data were decomposed with 3MD-VMI, 2MD, and DT to produce MSU-only and HA-only images. Mean values of 10 × 10 × 10-voxel volumes of interest (244 μm 3 ) placed in each MSU and HA phantom well were obtained and compared with their known concentrations and across measurements with subjects' extremities to obtain accuracy and precision measures. A statistical difference was considered significant if P < 0.05.

Results: Compared with known phantom standards, 3MD-VMI was accurate for the detection of MSU concentrations as low as 3.4 mg/dL ( P = 0.75). In comparison, 2MD was limited to 13.3 mg/dL ( P = 0.06) and DT was unable to detect MSU concentrations below 65.2 mg/L ( P = 0.16). For the HA phantom, 3MD-VMI and 2MD were accurate for all concentrations including the lowest at 100 mg/cm 3 ( P = 0.63 and P = 0.55, respectively). Dual-thresholding was not useful for the decomposition of HA phantom. Precision was high for both 3MD-VMI and 2MD measurements for both MSU and HA phantoms. Qualitatively, 3MD-VMI MSU-only images demonstrated reduced beam-hardening artifact and voxel misclassification, compared with 2MD and DT.

Conclusions: Three-material decomposition-VMI DECT is accurate for quantification of MSU and HA concentrations in phantoms and accurately detects a lower concentration of MSU than either 2MD or DT. For concentration measurements of both MSU and HA phantoms, 3MD-VMI and 2MD have high precision, but DT had limitations. Clinical implementation of 3MD-VMI DECT promises to improve the performance of this imaging modality for diagnosis and treatment monitoring of gout.

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Conflict of interest statement

Conflicts of interest and sources of funding: J.J.T. is supported by a Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship; M.T.K. is supported by a doctoral Natural Sciences and Engineering Research Council (NSERC, Canada) fellowship. S.L.M.'s research is supported by The Arthritis Society (Stars Early Career Investigator Award), NSERC, and the American Society for Bone and Mineral Research. Portions of the DECT code were supported by D.W.H.'s Canadian Institutes for Health Research (Foundation Grant) FDN 14874.

References

    1. Wallace SL, Robinson H, Masi AT, et al. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum . 1977;20:895–900.
    1. Chowalloor PV, Siew TK, Keen HI. Imaging in gout: a review of the recent developments. Ther Adv Musculoskelet Dis . 2014;6:131–143.
    1. Notzel A, Hermann K-G, Feist E, et al. Diagnostic accuracy of dual-energy computed tomography and joint aspiration: a prospective study in patients with suspected gouty arthritis. Clin Exp Rheumatol . 2018;36:1061–1067.
    1. Qaseem A, McLean RM, Starkey M, et al. Diagnosis of acute gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med . 2017;166:52–57.
    1. Neogi T, Jansen TLThA, Dalbeth N, et al. 2015 gout classification criteria: an American College of Rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheumatol . 2015;67:2557–2568.

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