AB0934 DUAL-ENERGY COMPUTED TOMOGRAPHY IN GOUT PATIENTS: IS IT USEFUL IN GENERAL PRACTICE?

Background:Dual-Energy CT (DECT) has high sensitivity and specificity for detecting monosodium urate (MSU) crystal deposition. Although widely used in research, few studies have evaluated the usefulness of DECT in clinical practice.Objectives:To evaluate the use of DECT in a clinical setting and determine its utilityMethods:We retrospectively evaluated the records of all patients referred for DECT scans over a 6.5-year period. Patient charts were reviewed for clinical features.Results:113 patients (17.5/yr) received DECT evaluation at a university hospital over the study period (234 scans). All were referred by rheumatologists. Medical records were available for 69 patients (134 scans), including 44 males and 25 females (mean age 62 (SD, 12.9, range: 34-85 yrs). Mean duration of gout was 6.7 (SD, 8.1) yrs. DECT was ordered to evaluate known gout (36/69, 52.1%), suspected gout (32/69, 46.4%), and suspected calcium pyrophosphate (CPP) disease (1/69, 1.4%). 32/69 (46.4%) of patients were on urate-lowering therapy.61% (42/69) had MSU crystal and none had CPP deposition. Mean MSU volume was 1.6cc (SD, 5.2cc; range: 0.01-35 cc.) The joints imaged were feet/ankles (80/134, 60%) and hands/wrists (53/134, 40%). 23/33 (69.7%) patients with DECT positivity had elevated serum urate (SU) levels >6mg/dL; however, elevated SU was not significantly associated with DECT positivity (odds ratio (OR) 1.9, 95% CI:0.59-5.95, p=0.28).For patients with positive scans, mean gout duration from first known flare was 9.5 (SD, 8.8) yrs.Among patients who had scans completed within 1 yr of the first known gout flare, 1/10 were positive (10%); 4/16 within 2 yrs (25%); and 8/21 within 3 yrs (29.6%).Of patients with positive DECT scans, 24/42 (57%) had symmetric distribution of MSU crystal deposition: 10/24 (42%) hands and 14/24 (58%) feet; with gout duration of 7.9 (SD, 8.0) yrs.Conclusion:DECT was infrequently utilized and only by rheumatologists. Only 60 % of patients referred for DECT scanning because of known or suspected gout had MSU deposition. DECT was uncommonly positive in patients with a 1-3 yr history of gout. When positive, the MSU crystal deposition was symmetrical in most gout patients. DECT scans, while important in furthering our understanding of gout biology, are not routinely used in general practice and often do not provide important decision support information. Establishment of practice guidelines might be important in developing more appropriate utilization of DECT.Disclosure of Interests:Yekaterina Sherman: None declared, Peter Lipsky Consultant of: Horizon Therapeutics, Mark Bramwit: None declared, Naomi Schlesinger Grant/research support from: Pfizer, AMGEN, Consultant of: Novartis, Horizon Pharma, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Speakers bureau: Takeda, Horizon

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Urate crystal deposition in hyperuricemic children: a dual energy computed tomography study

Archives of Medical Science ◽

10.5114/aoms/89835 ◽

2021 ◽

Vol 17 (1) ◽

pp. 100-105

Author(s):

Qianqian Ying ◽

Jiapei Wang ◽

Yunyan Li ◽

Nan Sun ◽

Yazhen Di ◽

...

Keyword(s):

Rapid Onset ◽

Dual Energy ◽

Dual Energy Ct ◽

Coastal Regions ◽

Intense Pain ◽

Asymptomatic Group ◽

Crystal Deposition ◽

History Of ◽

Urate Crystal ◽

Joint Group

IntroductionThe incidence of hyperuricemia (HUA) at younger ages is increasing along the coastal regions of China. This study aimed to compare the frequency of dual energy CT (DECT) urate crystal deposition between symptomatic hyperuricemic children and asymptomatic hyperuricemic children.Material and methodsFifty-six hyperuricemic children were divided into a Joint Group (n = 33) and an Asymptomatic Group (n = 23) according to whether they had a history of arthritis symptoms, which includes rapid onset monoarthritis with intense pain and swelling. We analyzed DECT scans of their feet from the Joint Group and the Asymptomatic Group and compared their clinical features.ResultsDECT urate deposits were observed in 28/33 (84.8%) children with symptomatic HUA and 14/23 (60.9%) with asymptomatic HUA. We found 60 areas of urate deposition in the Joint Group; DECT urate crystal deposition was most frequently observed in the first metatarsophalangeal (MTP) joint (30.0%), ankle joint (15.0%), and calcaneus (13.3%). 39 urate deposits were found in the Asymptomatic Group; DECT urate crystal deposition was most frequently observed in the calcaneus (25.6%), the first MTP joint (17.9%), and the first phalanx (15.4%).ConclusionsUrate deposition can occur in children with HUA, and these deposits occur more frequently in hyperuricemic children with a history of arthritis symptoms. Also, the urate deposition in the first MTP joint and calcaneus was more prevalent than in other joints. It is important to give more attention to hyperuricemic children.

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Presence of monosodium urate crystal deposition by dual-energy CT in patients with gout treated with allopurinol

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-212046 ◽

2017 ◽

Vol 77 (3) ◽

pp. 364-370 ◽

Cited By ~ 21

Author(s):

Nicola Dalbeth ◽

Savvas Nicolaou ◽

Scott Baumgartner ◽

Jia Hu ◽

Maple Fung ◽

...

Keyword(s):

Severe Disease ◽

Serum Urate ◽

Dual Energy ◽

Dual Energy Ct ◽

Monosodium Urate ◽

Crystal Deposition ◽

Patient Global Impression ◽

The Usa ◽

Urate Crystal ◽

Crystal Volume

ObjectiveDual-energy CT (DECT) detects and quantifies monosodium urate (MSU) crystal deposition with high precision. This DECT study assessed crystal deposition in patients with gout treated with stable-dose allopurinol, and investigated potential clinical determinants for crystal deposition.MethodsPatients with gout treated with allopurinol ≥300 mg daily for at least 3 months were prospectively recruited from the USA and New Zealand, using monitored enrolment to include approximately 25% patients with palpable tophi and approximately 50% with serum urate (sUA) levels <6.0 mg/dL (<357µmol/L). MSU crystal deposition was measured in the hands/wrists, feet/ankles/Achilles and knees bilaterally. The presence and total volume of crystals were assessed by DECT and analysed according to sUA levels and gout characteristics.ResultsAmong 152 patients receiving allopurinol ≥300 mg/day for 5.1 years on average, 69.1% had crystal deposition on DECT, with a median total crystal volume of 0.16 cm3 (range: 0.01–19.53 cm3). The prevalence of crystal deposition ranged from 46.9% among patients with sUA <6.0 mg/dL and no palpable tophi to 90.0% among those with sUA ≥6.0 mg/dL and tophi. Total volume of crystal deposition was positively associated with sUA ≥6.0 mg/dL, gout flares within the past 3 months and tophi. Total volume of crystal deposition correlated positively with Patient Global Impression of Disease Activity scores.ConclusionA substantial proportion of patients without palpable tophi have MSU crystal deposition, despite receiving allopurinol doses ≥300 mg/day for a considerable duration. Patients with higher sUA and clinical features of severe disease have a higher frequency and greater volume of MSU crystal deposition.

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Effect of colchicine, methotrexate, and hydroxychloroquine therapy on cardiovascular outcomes in patients with calcium pyrophosphate crystal deposition disease

Modern Rheumatology Journal ◽

10.14412/1996-7012-2021-6-76-83 ◽

2021 ◽

Vol 15 (6) ◽

pp. 76-83

Author(s):

M. S. Eliseev ◽

E. V. Cheremushkina ◽

O. V. Zhelyabina ◽

M. N. Chikina ◽

A. A. Kapitonova ◽

...

Keyword(s):

Cardiovascular Events ◽

Serum Uric Acid Level ◽

Calcium Pyrophosphate ◽

Chronic Arthritis ◽

Cardiovascular Outcomes ◽

Crystal Deposition ◽

Crystal Deposition Disease ◽

Deposition Disease ◽

History Of ◽

Anti Inflammatory

Anti-inflammatory therapy, such as colchicine (COL), has been suggested to affect the incidence of cardiovascular events in patients with calcium pyrophosphate crystal deposition disease (CPPD).Objective: to study the effect of anti-inflammatory therapy with COL, hydroxychloroquine (HC), and methotrexate (MT) on cardiovascular outcomes in patients with CPPD.Patients and methods. The study included 305 patients with CPPD, the majority (62.30%) were women. The average follow-up period was 3.9±2.7 years. Among factors influencing cardiovascular outcome were considered: gender; age; smoking; alcohol intake >20 conventional doses per week; arterial hypertension; a history of cardiovascular diseases (CVD), in particular ischemic heart disease, acute myocardial infarction, acute cerebrovascular accident, chronic heart failure >III stage according to NYHA, as well as type 2 diabetes mellitus (DM); body mass index >25 kg/m2 and >30 kg/m2; cholesterol level (CHOL) >5.1 mmol/l; glomerular filtration rate (GFR) < 60 ml/min/1.73 m2; serum uric acid level >360 μmol/l; hypercalcemia (serum calcium level >2.62 mmol/L); CRP level >2 mg/l; the presence of hyperparathyroidism (parathyroid hormone level >65 pg/ml); CPPD phenotypes (asymptomatic, osteoarthritis with calcium pyrophosphate crystals, chronic arthritis, acute arthritis); intake of COL, HC, MT, glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs).Results and discussion. 264 patients were under dynamic observation. Any of the studied cardiovascular events were registered in 79 (29.9%) patients. During the observation period, 46 (17.4%) patients died, in 76.1% of cases the cause of death was CVD. Death from other causes was diagnosed in 11 (23.9%) patients. Non-fatal cardiovascular events were reported in 44 (16.7%) cases. The risk of cardiovascular events was higher in patients over 65 years of age (odds ratio, OR 5.97; 95% confidence interval, CI 3.33–10.71), with serum cholesterol levels ≥5.1 mmol/L (OR 1,95; 95% CI 1.04–3.65), GFR <60 ml/min/1.73 m2 (OR 2.78; 95% CI 1.32–5.56), history of CVD (OR 2,32; 95% CI 1.22–4.44). COL therapy reduced the risk of cardiovascular events (OR 0.20; 95% CI 0.11–0.39).Conclusion. Poor CVD outcomes in CPPD are associated with age, hypercholesterolemia, chronic kidney disease, and a history of CVD. The use of COL, in contrast to MT and HC, was accompanied by a decrease in cardiovascular risk.

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Dual energy CT findings in gout with rapid kilovoltage-switching source with gemstone scintillator detector

BMC Rheumatology ◽

10.1186/s41927-019-0104-5 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Elin Svensson ◽

Ylva Aurell ◽

Lennart T. H. Jacobsson ◽

Anton Landgren ◽

Valgerdur Sigurdardottir ◽

...

Keyword(s):

Synovial Fluid ◽

Dual Energy ◽

University Hospital ◽

Dual Energy Ct ◽

Kappa Statistics ◽

Monosodium Urate ◽

Beam Hardening ◽

Monosodium Urate Crystals ◽

Scintillator Detector ◽

Urate Crystals

Abstract Background A definite diagnosis of gout requires demonstration of monosodium urate crystals in synovial fluid or in tophi, which in clinical practice today seldom is done. Dual energy CT (DECT) has repeatedly been shown to be able to detect monosodium urate crystals in tissues, hence being an alternative method to synovial fluid microscopy. The vast majority of these studies were performed with CT scanners with two X-ray tubes. In the present study we aim to investigate if and at what locations DECT with rapid kilovoltage-switching source with gemstone scintillator detector (GSI) can identify MSU crystals in patients with clinically diagnosed gout. We also performed a reliability study between two independent readings. Methods Patients with new or established gout who had been examined with DECT GSI scanning of the feet at Sahlgrenska University Hospital, Mölndal between 2015 and 2018 were identified. Their medical records were sought for gout disease characteristics using a structured protocol. Urate deposits in MTP1, MTP 2–5, ankle/midfoot joints and tendons were scored semiquantatively in both feet and presence of artifacts in nail and skin as well as beam hardening and noise were recorded. Two radiologists performed two combined readings and scoring of the images, thus consensus was reached over the scoring at each occasion (Espeland et al., BMC Med Imaging. 2013;13:4). The two readings were compared with kappa statistics. Results DECT GSI could identify urate deposits in the feet of all 55 participants with gout. Deposits were identified in the MTP-joints of all subjects but were also present in ankle/midfoot joints and tendons in 96 and 75% respectively. Deposition of urate was predicted by longer disease duration (Spearman’s Rho 0.64, p < .0001) and presence of tophi (p = 0.0005). Artifacts were common and mostly found in the nails (73%), a minority displayed skin artifacts (31%) while beam hardening and noise was rare. The agreement between the two readings was good (Κ = 0.66, 95% CI = 0.61–0.71). Conclusion The validity of DECT GSI in gout is supported by the identification of urate in all patients with clinical gout and the good correlations with clinical characteristics. The occurrence of artifacts was relatively low with expected locations.

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