scholarly journals Gout of feet and ankles in different disease durations: diagnostic value of single-source DECT and evaluation of urate deposition with a novel semi-quantitative DECT scoring system

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Jin Shang ◽  
Xiao-Hu Li ◽  
Shu-Qin Lu ◽  
Yi Shang ◽  
Lu-Lu Li ◽  
...  
Keyword(s):  
Scoring System ◽  
Diagnostic Performance ◽  
Disease Duration ◽  
Bone Erosion ◽  
Early Stage ◽  
Gouty Arthritis ◽  
Single Source ◽  
Crystal Deposition ◽  
Urate Crystal ◽  
Sensitivity Specificity

Abstract Objectives To investigate the diagnostic performance of single-source dual-energy computed tomography (DECT) based on gemstone spectral imaging technology (including Discovery CT750HD and Revolution CT) in patients with suspected feet/ankles gouty arthritis, and evaluate the urate deposition with a novel semi-quantitative DECT scoring system. Methods A total of 196 patients were consecutively included. Feet and ankles were evaluated in all patients by single-source DECT scan. The 2015 EULAR/ACR criteria were used as the reference for the diagnosis of gout. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of DECT for the diagnosis of gout in the early (≤1 year), middle (1–3 years), and late (> 3 years) disease durations were calculated. Besides, a novel semi-quantitative DECT scoring system was assessed for the measurement of urate deposition, and the correlation between the scores and the clinical and serological data were also evaluated. Moreover, the influences of artifacts on the diagnostic performance of DECT were also determined. Results The sensitivity, specificity, and AUC of DECT in 196 patients were 38.10, 96.43%, and 0.673 in the early-stage group; 62.96, 100.00%, and 0.815 in the middle-stage group; and 77.55, 87.50%, and 0.825 in the late-stage group, respectively. The overall diagnostic accuracies in the AUC of DECT (Discovery CT750HD and Revolution CT) in the middle and late stages of gout were higher than that in the early stage of gout. Besides, the monosodium urate crystals were deposited on the first metatarsophalangeal joints and ankles/midfeet. Age, the presence of tophus, bone erosion, and disease duration considerably affected the total urate score. No statistical difference in the positive detection of nail artifact, skin artifact, vascular calcification, and noise artifact was found between the case and control groups. Conclusion DECT (Discovery CT750HD and Revolution CT) showed promising diagnostic accuracy for the detection of urate crystal deposition in gout but had limited diagnostic sensitivity for short-stage gout. Longer disease duration, the presence of tophus, and bone erosion were associated with the urate crystal score system. The artifacts do not remarkably affect the diagnostic performance of DECT in gout.

Diagnostic Performance of Risk of Ovarian Malignancy Algorithm Against CA125 and HE4 in Connection With Ovarian Cancer: A Meta-analysis

2016 ◽  
Vol 26 (9) ◽  
pp. 1586-1593 ◽  
Author(s):  
Farshid Dayyani ◽  
Steffen Uhlig ◽  
Bertrand Colson ◽  
Kirsten Simon ◽  
Vinzent Rolny ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Late Stage ◽  
Diagnostic Performance ◽  
Clinical Decision Making ◽  
Early Stage ◽  
Area Under The Curve ◽  
Ovarian Malignancy ◽  
Eligibility Criteria ◽  
Sensitivity Specificity

ObjectivesThe aim of this study was to determine whether the Risk of Ovarian Malignancy Algorithm (ROMA) is more accurate than the human epididymis 4 (HE4) or carbohydrate antigen 125 (CA125) biomarkers with respect to the differential diagnosis of women with a pelvic mass. The secondary objective is to assess the performance of ROMA in early-stage ovarian cancer (OC) and late-stage OC, as well as premenopausal and postmenopausal patient populations.Methods/MaterialsThe PubMed and Google Scholar databases were searched for relevant clinical studies. Eligibility criteria included comparison of ROMA with both HE4 and CA125 levels in OC (unspecified, epithelial, and borderline ovarian tumors), use of only validated ROMA assays, presentation of area under the curve and sensitivity/specificity data, and results from early-stage OC, late-stage OC and premenopausal and postmenopausal women. Area under the curve (AUC), sensitivity/specificity, and the diagnostic odds ratio (DOR) results were summarized.ResultsFive studies were selected comprising 1975 patients (premenopausal, n = 1033; postmenopausal, n = 925; benign, n = 1387; early stage, n = 192; and late stage, n = 313). On the basis of the AUC (95% confidence interval) data for all patients, ROMA (0.921 [0.855–0.960]) had a numerically greater diagnostic performance than CA125 (0.883 [0.771–0.950]) and HE4 (0.899 [0.835–0.943]). This was also observed in each of the subgroup populations, in particular, the postmenopausal patients and patients with early OC. The sensitivity and specificity (95% confidence interval) results showed ROMA (sensitivity, 0.873 [0.752–0.940]; specificity, 0.855 [0.719–0.932]) to be numerically superior to CA125 (sensitivity, 0.796 [0.663–0.885]; specificity, 0.825 [0.662–0.919]) and HE4 (sensitivity, 0.817 [0.683–0.902]; specificity, 0.851 [0.716–0.928]) in all patients and for the early- and late-stage OC subgroups. Finally, the ROMA log DOR results were better than HE4 and CA125 log DOR results especially for the early-stage patient group.ConclusionsThe results presented support the use of ROMA to improve clinical decision making, most notably in patients with early OC.

scholarly journals Evaluation of Chest CT Findings within the Reporting and Data System of Patients with Suspected COVID-19 Infection

2021 ◽  
Keyword(s):  
Predictive Value ◽  
Scoring System ◽  
Diagnostic Performance ◽  
Operating Characteristic ◽  
Interobserver Agreement ◽  
Diagnostic Value ◽  
Data System ◽  
Ct Findings ◽  
Polymerase Chain ◽  
Sensitivity Specificity

Background: This study aimed to evaluate the diagnostic performance of the coronavirus disease 2019 (COVID-19) imaging reporting and data system (CO-RADS) in admitted patients with suspected COVID-19 infection. Methods: This retrospective study included all patients admitted to our hospital with COVID-19 pneumonia suspicion within March 20-May 15, 2020, who were examined by both computed tomography (CT) and real-time reverse transcription polymerase chain reaction (rRT-PCR) at initial presentation. Four radiologists, who were blinded to the rRT-PCR results and medical history, assessed all images independently and classified the CT findings according to the CO-RADS previously defined. Diagnostic value of the scoring system and interobserver agreement in rRT-PCR positive-negative groups and for CO-RADS 1-5 were evaluated. Results: In this study, 274 (153 men and 121 women; 48.8±17.3 years) rRT-PCR positive and 437 (208 men and 229 women; 49.0±19.5 years) rRT-PCR negative individuals were included. It was found that CO-RADS had a good diagnostic performance with area under the receiver operating characteristic roc curve of 0.857. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were obtained at 81.9%, 89.4%, 75.7%, 92.5%, and 84.8%, respectively. The interobserver agreement of four radiologists in CO-RADS 1 and 5 was substantial to almost perfect according to the kappa values. Other CO-RADS scores showed a fair to moderate agreement. The interrater agreement was slightly higher in the PCR (-) patient group than in the positive one. Conclusion: In conclusion, CO-RADS was a successful scoring system for distinguishing highly suspicious cases in terms of COVID-19 infection lung involvement, showing high interobserver agreement.

scholarly journals Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ling Cao ◽  
Tianyi Zhao ◽  
Chunmei Xie ◽  
Shucong Zheng ◽  
Weiguo Wan ◽  
...  
Keyword(s):  
Bone Erosion ◽  
Gouty Arthritis ◽  
Monosodium Urate ◽  
Crystal Deposition ◽  
Lowering Therapy ◽  
Asymptomatic Patients ◽  
Ultrasound Findings ◽  
History Of ◽  
Early Performance ◽  
Ultrasonic Assessment

Objective. To evaluate monosodium urate (MSU) crystal deposition and related lesions in the joints of patients with gout and hyperuricemia (HUA) using ultrasound. To explore the association between ultrasound findings and clinical features in gout and HUA. Methods. A total of 202 patients with gout and 43 asymptomatic patients with HUA were included. The clinical data and ultrasonic assessment results were collected and statistically analyzed. Results. Deposition of MSU crystals was found in 25.58% (11/43) of patients with asymptomatic HUA and 76.24% (154/202) of patients with gout. Of the 1,082 joints from patients with gout examined, 33.09% (358/1082) displayed MSU crystal deposition. In the joints with MSU crystal deposition, 77.37% (277/358) had a history of attacks. Among the joints of gouty arthritis, double contour sign (DCS), hyperechoic aggregate (HAG), and tophi were found in 32.65% (159/487), 7.80% (38/487), and 24.64% (120/487) of the joints, respectively. DCS and tophi, but not HAG, increasingly appeared with the extension of gout duration. In patients with more than 15 years of gout history, DCS, Tophi, and HAG were found in 48.18%, 40.00%, and 6.36% of US assessed joints, respectively. In patients with gout, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. The synovial lesion was related to HAG, while bone erosion was related to tophi and DCS. Nephrolithiasis was detected in 20.30% (41/202) of patients with gout and 4.65% (2/43) of HUA patients, indicating that nephrolithiasis occurred in more patients with gout than in patients with HUA. Conclusion. HAG is an early performance of MSU crystal deposition in joints of gout and HUA. Both DCS and tophi are risk factors for bone erosion. Early urate-lowering therapy (ULT) should be considered in patients with gout, DCS, or tophi.

scholarly journals Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

2020 ◽  
Author(s):  
Ling Cao ◽  
Tianyi Zhao ◽  
Chunmei Xie ◽  
Shucong Zheng ◽  
Weiguo Wan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Erosion ◽  
Gouty Arthritis ◽  
Objective Evaluation ◽  
Monosodium Urate ◽  
Crystal Deposition ◽  
Lowering Therapy ◽  
History Of ◽  
Msu Crystals ◽  
Double Contour

Abstract Objective Evaluation of monosodium urate (MSU) crystal deposition and related lesion in joints using ultrasound in gout and hyperuricemia patients. Methods Total 202 gout patients and 43 asymptomatic hyperuricemia patients were included, the clinical data and ultrasounic assessment results were collected and statistically analyzed. Results Deposition of MSU crystals were found in 25.58% (11/43) of the patients with asymptomatic hyperuricemia and 76.24% (154/202) of the patients with gout. In the all examined 1082 joints from gout patients, 33.09% (358/1082) of them were detected MSU crystals. In MSU crystal positive joints, 77.37% (277/358) of them had history of attacks. Among the joints of gouty arthritis, 56.88% (277/487) of them were found MSU crystals. Double contour sign (DCS), hyperechoic aggregate (HAG) and Tophi were found in 32.65% (159/487), 7.80% (38/487) and 24.64% (120/487) of the joints, respectively. DCS and Tophi, but not HAG, appeared inceasingly in gout duration extension. In the patients with more than 15 years of gout history, DCS, Tophi and HAG were found in 48.18%, 40.00%, 6.36% of US assessed joints, respectively. In the gout patients, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. Synovial lesion was related with HAG, while bone erosion was related to tophi and DCS. Conclusion HAG is the early sign of MSU crystal deposition in joints. Early urate lowering therapy (ULT) may reduce HAG and ameliorate synovitis and synovial hypertrophy. DCS and tophi are the risk factors of bone erosion. Early ULT should be considered in the gout patients with DCS or tophi.

scholarly journals Differential value of brain magnetic resonance imaging in multiple system atrophy cerebellar phenotype and spinocerebellar ataxias

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Minkyeong Kim ◽  
Jong Hyeon Ahn ◽  
Yoonsu Cho ◽  
Ji Sun Kim ◽  
Jinyoung Youn ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Multiple System Atrophy ◽  
Disease Duration ◽  
Early Stage ◽  
Brain Magnetic Resonance Imaging ◽  
Diagnostic Value ◽  
Spinocerebellar Ataxias ◽  
Resonance Imaging ◽  
Sensitivity Specificity

AbstractClinically differentiating multiple system atrophy cerebellar (MSA-C) phenotype and spinocerebellar ataxias (SCAs) is challenging especially in the early stage. We assessed diagnostic value of brain magnetic resonance imaging (MRI) in differentiating MSA-C and SCAs based at different disease stages (<3, 3–7, and >7 years of disease duration). Overall, 186 patients with probable MSA-C and 117 with genetically confirmed SCAs were included. Hot cross bun (HCB) signs and middle cerebellar peduncle (MCP) hyperintensities were exclusively prevalent in MSA-C compared to SCAs at <3 years (HCB, 44.6% versus 0.9%; MCP hyperintensities, 38.3% versus 0.9%, respectively). Sensitivity, specificity, and positive predictive value (PPV) for HCB signs to differentiate MSA-C from SCAs were 45%, 99%, and 99% and those for MCP hyperintensities were 68%, 99%, and 99%, respectively; considering both HCB signs and MCP hyperintensities, specificity and PPV were 100%. However, the differential value of MRI signs decreased over time. MCP widths were smaller and showed more significant decrease in MSA-C than in SCAs. In conclusion, pontine and MCP changes were exclusively prominent in early stage MSA-C rather than in SCAs. Therefore, we should consider disease duration when interpreting pontine and MCP changes in brain MRIs, which will help better differentiate MSA-C and SCAs.

The pathogenesis of bone erosions in gouty arthritis

2010 ◽  
Vol 69 (11) ◽  
pp. 1907-1912 ◽  
Author(s):  
Naomi Schlesinger ◽  
Ralf G Thiele
Keyword(s):  
Gouty Arthritis ◽  
Bone Destruction ◽  
Joint Space ◽  
Low Grade ◽  
Crystal Deposition ◽  
Bone Erosions ◽  
Urate Crystal ◽  
Gouty Tophus ◽  
High Resolution Ultrasonography ◽  
Low Grade Inflammation

The characteristic radiographic hallmarks of chronic gouty arthritis are the presence of macroscopic tophi and erosions with overhanging edges and relative preservation of the joint space. In recent years there has been more insight into the processes underlying the development of bone erosions in gouty arthritis. This review discusses the mechanical, pathological, cellular and immunological factors that may have a role in the pathogenesis of bone erosions in gouty arthritis. It highlights the evidence suggesting that monosodium urate crystal deposition is associated with the presence of underlying osteoarthritis and the important role of osteoclasts and the receptor for activation of nuclear factor κ B (RANK) and RANK ligand (RANK–RANKL) pathway in the pathogenesis of gouty erosions. Gouty arthritis is primarily driven by interleukin 1β (IL-1β). IL-1β has been implicated in bone destruction and erosions in other inflammatory arthridities. Thus, future IL-1 inhibitors may prevent and treat erosion formation due to tophaceous gouty arthritis. This review discusses imaging modalities and highlights ultrasongraphic evidence suggesting a significant relationship between the presence of the gouty tophus and bone erosions as well as the frequent presence of persistent low-grade inflammation in asymptomatic chronic tophaceous gouty arthritis on high-resolution ultrasonography. It is the tophus eroding the underlying bone that is pivotal for the development of bone erosions in gouty arthritis.

Introduction to gout

2016 ◽  
Author(s):  
Nicola Dalbeth
Keyword(s):  
Inflammatory Arthritis ◽  
Scientific Literature ◽  
Gouty Arthritis ◽  
Joint Damage ◽  
Monosodium Urate ◽  
Crystal Deposition ◽  
Treatment Targets ◽  
Urate Crystal ◽  
Practical Information ◽  
Low Levels

Gout is a chronic condition of monosodium urate crystal deposition. It is the most common form of inflammatory arthritis in adults, and leads to recurrent flares of severe joint damage and musculoskeletal disability. Although treatment targets are well defined, gout management is currently poor, with low levels of treatment targets achieved. The last decade has seen major advances in the understanding and treatment of gout. This handbook summarizes key scientific advances, including new insights into mechanisms of hyperuricaemia, acute gouty arthritis, and joint damage. Principles of gout diagnosis and management are discussed in detail, with practical information about use of well-established agents and also newer therapies. Gout-specific research tools are outlined to assist clinicians with interpretation of the latest scientific literature in gout. Future strategies for improved gout management are also discussed.

scholarly journals Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia

2020 ◽  
Author(s):  
Ling Cao ◽  
Tianyi Zhao ◽  
Xiaoxia Zhu ◽  
Chunmei Xie ◽  
Shucong Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Evaluation ◽  
Bone Erosion ◽  
Gouty Arthritis ◽  
Monosodium Urate ◽  
Crystal Deposition ◽  
Lowering Therapy ◽  
History Of ◽  
Msu Crystals ◽  
Double Contour

Abstract BackgroundEvaluation of monosodium urate (MSU) crystal deposition and related lesion in joints using ultrasound in gout and hyperuricemia patients. MethodsTotal 202 gout patients and 43 asymptomatic hyperuricemia patients were included, the clinical data and ultrasunic assessment results were collected and statistically analyzed. ResultsDeposition of MSU crystals were found in 25.58% (11/43) of the patients with asymptomatic hyperuricemia and 76.24% (154/202) of the patients with gout. In the all examined 1082 joints from gout patients, 33.09% (358/1082) of them were detected MSU crystals. In MSU crystal positive joints, 77.37% (277/358) of them had history of attacks. Among the joints of gouty arthritis, 56.88% (277/487) of them were found MSU crystals. Double contour sign (DCS), hyperechoic aggregate (HAG) and Tophi were found in 32.65% (159/487), 7.80% (38/487) and 24.64% (120/487) of the joints, respectively. DCS and Tophi, but not HAG, appeared increasingly in gout duration extension. In the patients with more than 15 years of gout history, DCS, Tophi and HAG were found in 48.18%, 40.00%, 6.36% of US assessed joints, respectively. In the gout patients, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. Synovial lesion was related with HAG, while bone erosion was related to tophi and DCS. Nephrolithiasis was detected in 20.30% (41/202) of gout patients and 4.65% (2/43) of hyperuricemia patients, indicating nephrolithiasis occurred in more gout patients than in hyperuricemia patients.ConclusionHAG is the early sign of MSU crystal deposition in joints. Early urate lowering therapy (ULT) may reduce HAG and ameliorate synovitis and synovial hypertrophy. DCS and tophi are the risk factors of bone erosion. Early ULT should be considered in the gout patients with DCS or tophi. And nephrolithiasis was remarkably relevant to MSU crystal deposition in joints in gout patients.

scholarly journals POS0132 IS THE INTERCRITICAL GOUT REALLY ASYMPTOMATIC? THE INFLAMMATORY ROLE OF THE SILENT URATE CRYSTAL DEPOSITION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 277.1-278
Author(s):  
C. Diaz-Torne ◽  
M. A. Ortiz ◽  
S. Jeria Navarro ◽  
A. Garcia-Gullien ◽  
L. Sainz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Whole Body ◽  
Subclinical Inflammation ◽  
Monosodium Urate ◽  
Crystal Deposition ◽  
Secretome Analysis ◽  
Healthy Donors ◽  
Cytokine Levels ◽  
Urate Crystal ◽  
Crystal Deposit

Background:Gout is the most prevalent inflammatory arthritis. Gout is chronic inflammatory deposition disease related to an increase of cardiovascular (CV) events and mortality. Subclinical chronic inflammation has been demonstrated in this patients but not its relation with the monosodium urate (MSU) crystal deposit size and the number of CV risk factors.Objectives:To study the subclinical inflammation in intercritical gout patients and its possible relation to the estimated size of the crystal deposition and the number of CV risk factors.Methods:To analyze subclinical inflammation we performed a secretome analysis and a cytokine and adiponektine plasma levels quantification (IL-1β, IL-18, IL-6, sIL-6R, TNFα, CXCL-5, RANTES, leptin, resistin and adiponectin) in a cohort of gout patients. As nowadays it is not feasible to determinate the whole body deposit of MSU crystals we created three different MSU crystal deposit size patient groups using an indirect clinical and analytical classification to estimate it. Then we compared cytokine levels between healthy donors and gout patients. We also compared cytokine levels between the different crystal size deposition groups and studied its association to the number of CV risk factors.Results:Ninety consecutive patients attending a Crystal Arthritis Unit were studied. Mean age was 68.27 (28-101) years. 81.1% were male. Clinical gout evolution was of 10.1±9.8 years. 77.5% were on urate lowering treatment. 24% had tophaceous gout. Mean uric acid was 6.3±2.1 mg/dl with 47.1% of them being on target. Hypertension was present in 68.9%, diabetes mellitus in 18.9%, dislipemia in 48.9%, BMI>30 in 32.9%, abdominal obesity in 50% and 16.1% suffered from ischemic heart disease. From the 102 molecules studied in the secretome analysis in 56 there was at least a 20% difference between donors group and any of the deposition groups. In 74% of them gout patients secreted lower levels. IL-18, sIL-6R, RANTES, leptin and adiponectin were higher in patients than in healthy donors. IL-18, sIL6-R, RANTES and CXCL5 levels were associated to the size of the crystal deposits. IL-18, sIL-6R, RANTES and leptin were higher in gout groups with CV risk factors. IL-18, sIL6-R, RANTES and leptin were higher in gout patients with no risk factors when compared to healthy donors with no risk factors. We found no differences when comparing urate lowering treated and non-treated patients.Conclusion:Our results demonstrate that some proinflammatory cytokines and metabolic proteins are raised in intercritical gout patients. Some of them are different from the flare/inflammasome expected ones. In some cytokines this elevation is related to the size of the monosodium urate crystal deposit and/or to the number of cardiovascular risk factors. This cytokine changes could help to explain the increase of the cardiovascular events in gout patients.Disclosure of Interests:Cesar Diaz-Torne Grant/research support from: Received a grant from Grünenthal, Maria Angels Ortiz: None declared, Sicylle Jeria Navarro: None declared, Andrea Garcia-Gullien: None declared, Lluis Sainz: None declared, Hector Corominas: None declared, Silvia Vidal: None declared

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