The lack of association between the burden of monosodium urate crystals assessed with dual-energy computed tomography or ultrasonography with cardiovascular risk in the commonly high-risk gout patient

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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TO EVALUATE DECT’S ROLE IN GOUT AND EXAMINE THE RELATIONSHIP WITH CLINICAL AND PARACLINICAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2019.2.13 ◽

2019 ◽

pp. 78-83

Author(s):

Van Nam Tran ◽

Tam Vo ◽

Chi Cuong Nguyen ◽

Nguyen Thanh Nhan Vo ◽

Thanh Hai Phan

Keyword(s):

Computed Tomography ◽

Bone Structure ◽

Multivariate Logistic Regression Analysis ◽

Dual Energy ◽

Original Research ◽

Cross Sectional ◽

Crystal Deposition ◽

Dual Energy Computed Tomography ◽

The Relationship ◽

Urate Crystals

Background: To identify Urate crystals from synovial fluid under polarized microscopy is considered the gold standard in diagnosing Gout disease. However, it is not always possible to suck up enough fluid or in case of pain, it is impossible to suck the fluid. Dual-energy Computed Tomography (DECT) is a new tool for diagnosing Gout disease. DECT shows the deposition of urate crystals and bone structure images using different display colors. However, there is no agreement from the research results in the world. In Vietnam, no original research has been published. Objective: To evaluate DECT’s role in Gout and examine the relationship with clinical and paraclinical factors. Methods: A cross-sectional study was conducted in patients who visited the Hoa Hao-Medic clinic in Ho Chi Minh City. Gout disease is diagnosed with clinical and paraclinical criteria; and have DECT results. The cases were selected continuously, there were no cases of losing samples. Multivariate logistic regression analysis was used to determine the independent association between clinical and paraclinical variables with DECT images. Results: 61 out of 80 Gout patients with DECT positive accounted for 77.25%, There was an association between DECT and number of Gout attacks (> 3 times), duration of illness (> 36 months), tophi seeds. No correlation was found between clinical variables and background characteristics in the study. In the subclinical, urate crystal deposition images show a clear imprint on goute disease, while other variables do not find expression. Conclusion: DECT is closely related to the frequency of gout attacks, disease duration and tophi. Gout disease is a consequence of lifestyle behaviors, inappropriate eating habits, and exposure to risk factors in life. Key words: DECT (Dual-energy Computed Tomography), Hoa Hao-Med, Gout

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