The utility of dual-energy computed tomography angiography for the evaluation of brain aneurysms after endovascular coiling: a prospective study

Acta Radiologica ◽

10.1177/02841851211066754 ◽

2021 ◽

pp. 028418512110667

Author(s):

Parviz Dolati ◽

Christopher S Ogilvy

Keyword(s):

Computed Tomography ◽

Cerebral Aneurysm ◽

Sensitivity And Specificity ◽

Computed Tomography Angiography ◽

Dual Energy ◽

Endovascular Coiling ◽

Dual Energy Computed Tomography ◽

Non Invasive ◽

Brain Aneurysms ◽

A Prospective Study

Background Non-invasive alternatives to digital subtraction angiography (DSA) for follow-up of patients with coiled aneurysms are sought. Purpose To compare a novel method of dual-energy computed tomography angiography (DE-CTA) for postoperative assessment of coiled brain aneurysms to detect aneurysm recanalization and patency of adjacent blood vessels, with DSA. Material and Methods Patients who underwent endovascular cerebral aneurysm coiling were prospectively evaluated postoperatively by both DE-CTA and conventional DSA. CTA was performed using a novel dual-energy method with single-source and fast kilovoltage switching. DSA was performed using biplanar cerebral angiography. An experienced neuroradiologist and neurosurgeon, both blinded to the original radiological results, reviewed the images. Results A total of 54 patients (16 men, 38 women; mean age=47.6 + 9 years) with 55 coiled aneurysms were enrolled in our study between July 2014 and June 2015: 29 patients had suffered a subarachnoid hemorrhage and 26 patients had an incidentally found cerebral aneurysm. All patients had at least one DSA and DE-CTA performed at most one week apart. DE-CTA showed a 100% sensitivity and specificity in detection of complete aneurysm occlusion and 80% sensitivity and specificity for detection of residual necks and domes. DE-CTA successfully detected all vascular diameter changes as comparable to DSA with minimal interfering artifact. Conclusion DE-CTA is a promising non-invasive alternative to conventional catheter-based angiography for identification of aneurysm recurrence and assessment of adjacent arteries after endovascular coiling. It allows for far more rapid image acquisition than DSA, is non-invasive, and is widely available at clinical centers.

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Rationale and design of the dual-energy computed tomography for ischemia determination compared to “gold standard” non-invasive and invasive techniques (DECIDE-Gold): A multicenter international efficacy diagnostic study of rest-stress dual-energy computed tomography angiography with perfusion

Journal of Nuclear Cardiology ◽

10.1007/s12350-014-0035-x ◽

2014 ◽

Vol 22 (5) ◽

pp. 1031-1040 ◽

Cited By ~ 15

Author(s):

Quynh A. Truong ◽

Paul Knaapen ◽

Gianluca Pontone ◽

Daniele Andreini ◽

Jonathon Leipsic ◽

...

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Gold Standard ◽

Dual Energy ◽

Diagnostic Study ◽

Dual Energy Computed Tomography ◽

Non Invasive ◽

Invasive Techniques

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OP0318 THE ROLE OF DUAL ENERGY COMPUTED TOMOGRAPHY (DECT) IN THE DIFFERENTIATION OF GOUT AND CALCIUM PYROPHOSPHATE DEPOSITION DISEASE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4571 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 196.2-196 ◽

Cited By ~ 1

Author(s):

D. Kravchenko ◽

P. Karakostas ◽

P. Brossart ◽

C. Behning ◽

C. Meyer ◽

...

Keyword(s):

Computed Tomography ◽

Uric Acid ◽

Sensitivity And Specificity ◽

Gold Standard ◽

Calcium Pyrophosphate ◽

Dual Energy ◽

Laboratory Parameters ◽

Dual Energy Computed Tomography ◽

Non Invasive ◽

Calcium Pyrophosphate Deposition Disease

Background:Differentiation of gout and calcium pyrophosphate deposition disease (CPPD) is sometimes difficult as patients often present with a similar clinical picture. Arthrocentesis and subsequent polarization microscopy (PM) remains the gold standard but novel diagnostic approaches such as non-invasive dual energy computed tomography (DECT) have recently been validated for gout. Currently, limited data is available on DECT in patients with CPPD.Objectives:To analyse the diagnostic impact of DECT in gout and CPPD when compared to the gold standard of PM. We further compared the results of PM to ultrasound (US), conventional radiographs (CR), and suspected clinical diagnosis (SCD). Additionally, 15 laboratory parameters were analysed.Methods:Twenty-six patients diagnosed with gout (n = 18) or CPPD (n = 8) who received a DECT and underwent arthrocentesis were included. Two independent readers assessed colour coded, as well as 80 and 120 kV DECT images for signs of monosodium urate (MSU) crystals or CPP deposition. US and CR from the patient’s initial visit along with the SCD were also compared to PM. US examinations were performed by certified musculoskeletal ultrasound specialists. The association of up to 15 laboratory parameters such as uric acid, thyroid stimulating hormone, and C-reactive protein (CRP) with the PM results was analysed.Results:Sensitivity of DECT for gout was 67% (95% CI 0.41-0.87) with a specificity of 88% (95% CI 0.47-1.0). Concerning CPPD, the sensitivity and specificity of DECT was 63% (95% CI 0.25-0.91) and 83% (95% CI 0.59-0.96) respectively. US had the highest sensitivity of 89% (95% CI 0.65-0.99) with a specificity of 75% (95% CI 0.35-0.97) for gout, while the sensitivity and specificity for CPPD were 88% (95% CI 0.47-1.0) and 89% (95% CI 0.65-0.99) respectively. The SCD had the second highest sensitivity for gout at 78% (95% CI 0.52-0.94) with a comparable sensitivity of 63% (95% CI 0.25-0.92) for CPPD. Uric acid levels were elevated in 33% of gout patients and 25% of CPPD patients. While elevated CRP levels were observed in 59% of gout patients and in 88% of CPPD patients, none of the 15 analysed laboratory parameters were found to be significantly linked.Conclusion:DECT provides a non-invasive diagnostic tool for gout but might have a lower sensitivity than suggested by previous studies (67% vs 90%1). DECT sensitivity for CPPD was 63% (95% CI 0.25-0.91) in a sample group of eight patients. Both US and the SCD had higher sensitivities than DECT for gout and CPPD. Further studies with larger patient cohorts are needed in order to determine the diagnostic utility of DECT in CPPD.References:[1]Bongartz, Tim; Glazebrook, Katrina N.; Kavros, Steven J.; Murthy, Naveen S.; Merry, Stephen P.; Franz, Walter B. et al. (2015): Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. InAnnals of the rheumatic diseases74 (6), pp. 1072–1077. DOI: 10.1136/annrheumdis-2013-205095.Disclosure of Interests:None declared

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The role of dual energy computed tomography in the differentiation of acute gout flares and acute calcium pyrophosphate crystal arthritis

Clinical Rheumatology ◽

10.1007/s10067-021-05949-4 ◽

2021 ◽

Author(s):

Dmitrij Kravchenko ◽

Pantelis Karakostas ◽

Daniel Kuetting ◽

Carsten Meyer ◽

Peter Brossart ◽

...

Keyword(s):

Computed Tomography ◽

Sensitivity And Specificity ◽

Calcium Pyrophosphate ◽

Dual Energy ◽

Lower Sensitivity ◽

Acute Gout ◽

Dual Energy Computed Tomography ◽

Non Invasive ◽

Crystal Arthritis ◽

Gout Flares

Abstract Objectives To analyse the diagnostic impact of dual energy computed tomography (DECT) in acute gout flares and acute calcium pyrophosphate (CPP) crystal arthritis when compared to the gold standard of arthrocentesis with compensated polarised light microscopy. Microscopy results were also compared to musculoskeletal ultrasound (MUS), conventional radiographs, and the suspected clinical diagnosis (SCD). Methods Thirty-six patients with a suspected gout flare (n = 24) or acute CPP crystal arthritis (n = 11, n = 1 suffered from neither) who received a DECT and underwent arthrocentesis were included. Two independent readers assessed DECT images for signs of monosodium urate crystals or calcium pyrophosphate deposition. Results Sensitivity of DECT for gout was 63% (95% CI 0.41–0.81) with a specificity of 92% (0.41–0.81) while sensitivity and specificity for acute CPP arthritis were 55% (0.23–0.83) and 92% (0.74–0.99), respectively. MUS had the highest sensitivity of all imaging modalities with 92% (0.73–0.99) and a specificity of 83% (0.52–0.98) for gout, while sensitivity and specificity for acute CPP crystal arthritis were 91% (0.59–1.00) and 92% (0.74–0.99), respectively. Conclusion DECT is an adequate non-invasive diagnostic tool for acute gout flares but might have a lower sensitivity than described by previous studies. Both MUS and SCD had higher sensitivities than DECT for acute gout flares and acute CPP crystal arthritis. Key Points• DECT offers a lower sensitivity for acute gout flares than previously described.• DECT sensitivity for acute CPP crystal arthritis is less than the already validated ultrasound.

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