Imaging Pearls ❯ Dual Energy ❯ Gout
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- “ Initial retrospective assessment suggests that dual-energy CT is a sensitive, noninvasive, and reproducible method for identifying uric acid deposits in joints and periarticular soft tissues in patients suspected of having gout.”
Identification of Intraarticular and Periarticular Uric Acid Crystals with Dual-Energy CT: Initial Evaluation
Glazebrook KN et al.
Radiology 2011;261:516-524 - “ Dual-energy CT may be useful in establishing the extent of gout by identifying subclinical tophi and in identifying urate deposits in atypical anatomic sites for gout.”
Identification of Intraarticular and Periarticular Uric Acid Crystals with Dual-Energy CT: Initial Evaluation
Glazebrook KN et al.
Radiology 2011;261:516-524 - “ Unenhanced low dose dual energy CT can add information to joint fluid aspiration in patients suspected of having gout by aiding identification of uric acid deposits within joints and periarticular soft tissues.”
Identification of Intraarticular and Periarticular Uric Acid Crystals with Dual-Energy CT: Initial Evaluation
Glazebrook KN et al.
Radiology 2011;261:516-524
- “ A diagnosis of gout is generally straightforward and is usually reached by evaluating clinical, laboratory, and radiologic findings. By using specific attenuation characteristics to differentiate urate crystals from calcium, dual energy CT may be helpful when the diagnosis is unclear, as in cases of atypical clinical manifestations, discordant levels of serum urate, or in differentiating an acute attack from chronic changes.”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Desai MA et al.
RadioGraphics 2011;31:1365-1375 - “ Dual-energy CT may be used to differentiate uric acid from calcium in musculoskeletal tissue, allowing gouty urate crystals to be distinguished from bone or dystrophic calcifications.”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Desai MA et al.
RadioGraphics 2011;31:1365-1375 - “ In the most common clinical manifestations of acute gout, rapid onset of a painful monoarthopathy occurs in the distal appendicular skeleton, often in the first metatarsophalangeal joint, in a middle aged man or postmenopausal woman.”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Desai MA et al.
RadioGraphics 2011;31:1365-1375 - “ In the most common clinical manifestations of acute gout, rapid onset of a painful monoarthopathy occurs in the distal appendicular skeleton, often in the first metatarsophalangeal joint, in a middle aged man or postmenopausal woman. Atypical clinical manifestations also are seen with increased frequency in certain segments of the population, including the elderly and patients who underwent organ transplantation and those with a tumor, prostheses and genetic mutations.”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Desai MA et al.
RadioGraphics 2011;31:1365-1375 - “ Unlike other modalities, dual energy CT is inherently able to distinguish urate crystal deposits from surrounding structures, and it provides sensitive and specific volumetric quantification with no user variability.”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Desai MA et al.
RadioGraphics 2011;31:1365-1375 - Mimics of Gout: Differential Diagnosis
- Septic arthritis
- Osteomyelitis
- Pseudogout (calcium pyrophosphate deposition disease)
- Rheumatoid arthritis
- Malignancy (lytic lesion)
-Tendinopathy - Role of Dual Energy CT in the Diagnosis of Gout as a Problem Solver
- Unusual clinical presentations
- Discordant uric acid levels
- Acute vs chronic gout
- Subclinical disease
- Mimics of gout vs gout
- Quantification of gout for therapy monitoring - DE Protocol
Single acquisition at both 80 and 140 kVp
Color coded mapping with Green being positive for urate crystals
3D mapping useful for defining extent of disease - “DECT scans can produce obvious colour displays for urate deposits and help to identify subclinical tophus deposits. Furthermore, tophus volume can be measured by DECT scans through an automated volume estimation procedure.”
Dual energy computed tomography in tophaceous gout
Choi HK et al.
Ann Rheum Dis 2009;68:1609-1612 - “Although diagnosing gout generally is straightforward, atypical disease may present a challenge if it is associated with unusual symptoms or sites, discordant serum urate level, or mimics of gout. Dual-energy computed tomography (CT) may be used to differentiate urate crystals from calcium by using specific attenuation characteristics, which may help diagnose gout. In patients with known tophaceous gout, dual-energy CT may be used for serial volumetric quantification of subclinical tophi to evaluate response to treatment. Given the utility of dual-energy CT in challenging cases and its ability to provide an objective outcomes measure in patients with tophaceous gout, dual-energy CT promises to be a unique and clinically relevant modality in the diagnosis and management of gout.”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Deasia MA et al.
Radiographics September-October 2011 31:1365-1375; - “Dual-energy computed tomography (CT) may be used to differentiate urate crystals from calcium by using specific attenuation characteristics, which may help diagnose gout. In patients with known tophaceous gout, dual-energy CT may be used for serial volumetric quantification of subclinical tophi to evaluate response to treatment. Given the utility of dual-energy CT in challenging cases and its ability to provide an objective outcomes measure in patients with tophaceous gout, dual-energy CT promises to be a unique and clinically relevant modality in the diagnosis and management of gout.”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Deasia MA et al.
Radiographics September-October 2011 31:1365-1375 - “Gout is characterized by the inflammatory response that results from the deposition of monosodium urate crystals in soft tissues and joints. Crystal deposition may lead to acute or chronic arthropathy and the formation of gouty tophi, nodular masslike aggregates of urate crystals (1). Gout is the most common crystalline type of arthropathy in the United States, and its incidence and prevalence continue to increase.”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Deasia MA et al.
Radiographics September-October 2011 31:1365-1375 - “The gold standard for establishing a diagnosis of gout is to determine whether monosodium urate crystals are present in aspirated joint fluid or tophus. However, samples of joint fluid frequently are not obtained; in these cases, disease manifestation, serum urate levels, and radiologic findings are key to establishing a clinical diagnosis of gout (11,12). Several criteria for diagnosis have been developed over the years, including hyperuricemia, the presence of tophi or urate crystals, acute onset of painful monoarthropathy (especially at the first metatarsophalangeal joint), response to colchicine, and radiologic findings.”
- “Septic arthritis and osteomyelitis (Fig 12), pseudogout (calcium pyrophosphate deposition disease), and rheumatoid arthritis are common mimics of gout (31). Less often, malignancy, other arthritides (Fig 13), and tendinopathy (Fig 14) also may clinically imitate gout. Because of their overlapping symptoms and laboratory markers, inflammatory processes may be difficult to distinguish clinically, and they may be even more challenging to differentiate in patients with hyperuricemia or known gout elsewhere in the body. In such cases, dual-energy CT findings may be valuable in excluding urate crystal deposition, and they have been shown to help distinguish gout from inflammatory mimics such as psoriasis, rheumatoid arthritis, pseudogout, and pigmented villonodular synovitis .”
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Deasia MA et al.
Radiographics September-October 2011 31:1365-1375
Clinical Utility of Dual-Energy CT for Evaluation of Tophaceous Gout
Deasia MA et al.
Radiographics September-October 2011 31:1365-1375