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Erschienen in: European Radiology 3/2019

17.09.2018 | Musculoskeletal

Combining non-contrast and dual-energy CT improves diagnosis of early gout

verfasst von: Seul Ki Lee, Joon-Yong Jung, Won-Hee Jee, Jennifer Jooha Lee, Sung-Hwan Park

Erschienen in: European Radiology | Ausgabe 3/2019

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Abstract

Objectives

To determine the incremental value of non-contrast CT (NCCT) on dual-energy CT (DECT) in symptomatic first metatarsophalangeal (MTP) joints in early gout.

Methods

One hundred and fifteen painful joints were consecutively enrolled and gout was diagnosed based on the 2015 EULAR/ACR criteria and/or arthrocentesis. Two readers independently evaluated DECT alone and combined NCCT and DECT (NCCT+DECT) based on four semiquantitative scales. Sensitivities and specificities were compared using McNemar’s test. AUC was compared.

Results

Of the 115 joints, 72 were defined as an early gout group and 43 as a gout-negative group after exclusion. The sensitivity and specificity for the early gout group on DECT alone were as followed: reader 1 – 52.8% and 100.0% and reader 2 – 51.4% and 100.0%. NCCT+DECT results were as follows: reader 1 – 79.2% and 93.0% and reader 2 – 79.2% and 95.3%. AUC was significantly higher in NCCT+DECT compared to that in DECT alone for the early gout group (0.888 vs. 0.774 for reader 1, p = 0.0004; 0.896 vs. 0.816 for reader 2, p = 0.0142). The false-negative cases on DECT occurred more frequently with the first-onset gout, and tended to be affected by a longer duration of symptoms in the post-hoc analysis.

Conclusion

The combined analysis of NCCT and DECT improves diagnostic capabilities in symptomatic early gout involving the first MTP joint.

Key Points

• MSU crystal depositions in early gout may be seen on non-contrast CT, while still being undetectable by DECT.
• Combining non-contrast CT and DECT improves detection of early gout.
• False negatives of DECT are more common than previously reported in cases of first-onset gout.
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Metadaten
Titel
Combining non-contrast and dual-energy CT improves diagnosis of early gout
verfasst von
Seul Ki Lee
Joon-Yong Jung
Won-Hee Jee
Jennifer Jooha Lee
Sung-Hwan Park
Publikationsdatum
17.09.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 3/2019
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5716-4

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