Dual-energy CT for the diagnosis of gout: An accuracy and diagnostic yield study

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

Objectives: To assess the accuracy of dual-energy CT (DECT) for diagnosing gout, and to explore whether it can have any impact on clinical decision making beyond the established diagnostic approach using polarising microscopy of synovial fluid (diagnostic yield). Methods: Diagnostic single-centre study of 40 patients with active gout, and 41 individuals with other types of joint disease. Sensitivity and specificity of DECT for diagnosing gout was calculated against a combined reference standard (polarising and electron microscopy of synovial fluid). To explore the diagnostic yield of DECT scanning, a third cohort was assembled consisting of patients with inflammatory arthritis and risk factors for gout who had negative synovial fluid polarising microscopy results. Among these patients, the proportion of subjects with DECT findings indicating a diagnosis of gout was assessed. Results: The sensitivity and specificity of DECT for diagnosing gout was 0.90 (95% CI 0.76 to 0.97) and 0.83 (95% CI 0.68 to 0.93), respectively. All false negative patients were observed among patients with acute, recent-onset gout. All false positive patients had advanced knee osteoarthritis. DECT in the diagnostic yield cohort revealed evidence of uric acid deposition in 14 out of 30 patients (46.7%). Conclusions: DECT provides good diagnostic accuracy for detection of monosodium urate (MSU) deposits in patients with gout. However, sensitivity is lower in patients with recent-onset disease. DECT has a significant impact on clinical decision making when gout is suspected, but polarising microscopy of synovial fluid fails to demonstrate the presence of MSU crystals.

Original languageEnglish (US)
Pages (from-to)1072-1077
Number of pages6
JournalAnnals of the Rheumatic Diseases
Volume74
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Gout
Uric Acid
Microscopic examination
Fluids
Synovial Fluid
Decision making
Microscopy
Electron microscopy
Deposits
Scanning
Crystals
Sensitivity and Specificity
Joint Diseases
Knee Osteoarthritis
Arthritis
Electron Microscopy

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

@article{9830a1f76025417793be6de37c9835bc,
title = "Dual-energy CT for the diagnosis of gout: An accuracy and diagnostic yield study",
abstract = "Objectives: To assess the accuracy of dual-energy CT (DECT) for diagnosing gout, and to explore whether it can have any impact on clinical decision making beyond the established diagnostic approach using polarising microscopy of synovial fluid (diagnostic yield). Methods: Diagnostic single-centre study of 40 patients with active gout, and 41 individuals with other types of joint disease. Sensitivity and specificity of DECT for diagnosing gout was calculated against a combined reference standard (polarising and electron microscopy of synovial fluid). To explore the diagnostic yield of DECT scanning, a third cohort was assembled consisting of patients with inflammatory arthritis and risk factors for gout who had negative synovial fluid polarising microscopy results. Among these patients, the proportion of subjects with DECT findings indicating a diagnosis of gout was assessed. Results: The sensitivity and specificity of DECT for diagnosing gout was 0.90 (95{\%} CI 0.76 to 0.97) and 0.83 (95{\%} CI 0.68 to 0.93), respectively. All false negative patients were observed among patients with acute, recent-onset gout. All false positive patients had advanced knee osteoarthritis. DECT in the diagnostic yield cohort revealed evidence of uric acid deposition in 14 out of 30 patients (46.7{\%}). Conclusions: DECT provides good diagnostic accuracy for detection of monosodium urate (MSU) deposits in patients with gout. However, sensitivity is lower in patients with recent-onset disease. DECT has a significant impact on clinical decision making when gout is suspected, but polarising microscopy of synovial fluid fails to demonstrate the presence of MSU crystals.",
author = "Tim Bongartz and Glazebrook, {Katrina Nesta} and Kavros, {Steven J.} and Murthy, {Naveen S} and Merry, {Stephen P.} and Franz, {Walter B.} and Clement Michet and Veetil, {Barath M Akkara} and Davis, {John Manley III} and Thomas Mason and Warrington, {Kenneth J} and Ytterberg, {Steven R} and Matteson, {Eric Lawrence} and Cynthia Crowson and Shuai Leng and McCollough, {Cynthia H}",
year = "2015",
month = "6",
day = "1",
doi = "10.1136/annrheumdis-2013-205095",
language = "English (US)",
volume = "74",
pages = "1072--1077",
journal = "Annals of the Rheumatic Diseases",
issn = "0003-4967",
publisher = "BMJ Publishing Group",
number = "6",

}

TY - JOUR

T1 - Dual-energy CT for the diagnosis of gout

T2 - An accuracy and diagnostic yield study

AU - Bongartz, Tim

AU - Glazebrook, Katrina Nesta

AU - Kavros, Steven J.

AU - Murthy, Naveen S

AU - Merry, Stephen P.

AU - Franz, Walter B.

AU - Michet, Clement

AU - Veetil, Barath M Akkara

AU - Davis, John Manley III

AU - Mason, Thomas

AU - Warrington, Kenneth J

AU - Ytterberg, Steven R

AU - Matteson, Eric Lawrence

AU - Crowson, Cynthia

AU - Leng, Shuai

AU - McCollough, Cynthia H

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Objectives: To assess the accuracy of dual-energy CT (DECT) for diagnosing gout, and to explore whether it can have any impact on clinical decision making beyond the established diagnostic approach using polarising microscopy of synovial fluid (diagnostic yield). Methods: Diagnostic single-centre study of 40 patients with active gout, and 41 individuals with other types of joint disease. Sensitivity and specificity of DECT for diagnosing gout was calculated against a combined reference standard (polarising and electron microscopy of synovial fluid). To explore the diagnostic yield of DECT scanning, a third cohort was assembled consisting of patients with inflammatory arthritis and risk factors for gout who had negative synovial fluid polarising microscopy results. Among these patients, the proportion of subjects with DECT findings indicating a diagnosis of gout was assessed. Results: The sensitivity and specificity of DECT for diagnosing gout was 0.90 (95% CI 0.76 to 0.97) and 0.83 (95% CI 0.68 to 0.93), respectively. All false negative patients were observed among patients with acute, recent-onset gout. All false positive patients had advanced knee osteoarthritis. DECT in the diagnostic yield cohort revealed evidence of uric acid deposition in 14 out of 30 patients (46.7%). Conclusions: DECT provides good diagnostic accuracy for detection of monosodium urate (MSU) deposits in patients with gout. However, sensitivity is lower in patients with recent-onset disease. DECT has a significant impact on clinical decision making when gout is suspected, but polarising microscopy of synovial fluid fails to demonstrate the presence of MSU crystals.

AB - Objectives: To assess the accuracy of dual-energy CT (DECT) for diagnosing gout, and to explore whether it can have any impact on clinical decision making beyond the established diagnostic approach using polarising microscopy of synovial fluid (diagnostic yield). Methods: Diagnostic single-centre study of 40 patients with active gout, and 41 individuals with other types of joint disease. Sensitivity and specificity of DECT for diagnosing gout was calculated against a combined reference standard (polarising and electron microscopy of synovial fluid). To explore the diagnostic yield of DECT scanning, a third cohort was assembled consisting of patients with inflammatory arthritis and risk factors for gout who had negative synovial fluid polarising microscopy results. Among these patients, the proportion of subjects with DECT findings indicating a diagnosis of gout was assessed. Results: The sensitivity and specificity of DECT for diagnosing gout was 0.90 (95% CI 0.76 to 0.97) and 0.83 (95% CI 0.68 to 0.93), respectively. All false negative patients were observed among patients with acute, recent-onset gout. All false positive patients had advanced knee osteoarthritis. DECT in the diagnostic yield cohort revealed evidence of uric acid deposition in 14 out of 30 patients (46.7%). Conclusions: DECT provides good diagnostic accuracy for detection of monosodium urate (MSU) deposits in patients with gout. However, sensitivity is lower in patients with recent-onset disease. DECT has a significant impact on clinical decision making when gout is suspected, but polarising microscopy of synovial fluid fails to demonstrate the presence of MSU crystals.

UR - http://www.scopus.com/inward/record.url?scp=84934956973&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84934956973&partnerID=8YFLogxK

U2 - 10.1136/annrheumdis-2013-205095

DO - 10.1136/annrheumdis-2013-205095

M3 - Article

C2 - 24671771

AN - SCOPUS:84934956973

VL - 74

SP - 1072

EP - 1077

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - 6

ER -