Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: Initial evaluation

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Abstract

Purpose: To estimate the accuracy, sensitivity, specificity, and interobserver agreement of dual-energy computed tomography (CT) in detection of uric acid crystals in joints or periarticular structures in patients with arthralgia and patients suspected of having gout, with joint aspiration results as reference standard . Materials and Methods: With institutional review board approval, patient consent, and HIPAA compliance, 94 patients (age range, 29-89 years) underwent dual-source, dual-energy (80 and 140 kVp) CT of a painful joint. A material decomposition algorithm was used to identify uric acid. Two blinded musculoskeletal radiologists evaluated the dual-energy CT images and classifi ed the examination findings as positive or negative for the presence of uric acid crystals. Reference standard was the result of joint aspiration. Results: Forty-three of 94 patients (46%) underwent attempted joint aspiration within 1 month of dual-energy CT. Aspiration was successful in 31 of 43 patients (72%). In 12 of 31 patients (39%), uric acid crystals were identified at joint aspiration; in 19 patients, they were not. Readers 1 and 2 had no false-negative findings for uric acid at dual-energy CT. Sensitivity was 100% (12 of 12; 95% confidence interval (CI): 74%, 100%) for both readers. Specificity was 89% (17 of 19; 95% CI: 67%, 99% ) for reader 1 and 79% (15 of 19; 95% CI: 54%, 94%) for reader 2, with nearperfect agreement between the readers(κ = 0.87; range, 0.70-1.00) in the 31 patients who underwent aspiration. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)516-524
Number of pages9
JournalRadiology
Volume261
Issue number2
DOIs
StatePublished - Nov 2011

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Uric Acid
Tomography
Joints
Gout
Confidence Intervals
Health Insurance Portability and Accountability Act
Research Ethics Committees
Arthralgia
Patient Compliance
Aspirations (Psychology)
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{170681d78c654a52a4fa6619ef555901,
title = "Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: Initial evaluation",
abstract = "Purpose: To estimate the accuracy, sensitivity, specificity, and interobserver agreement of dual-energy computed tomography (CT) in detection of uric acid crystals in joints or periarticular structures in patients with arthralgia and patients suspected of having gout, with joint aspiration results as reference standard . Materials and Methods: With institutional review board approval, patient consent, and HIPAA compliance, 94 patients (age range, 29-89 years) underwent dual-source, dual-energy (80 and 140 kVp) CT of a painful joint. A material decomposition algorithm was used to identify uric acid. Two blinded musculoskeletal radiologists evaluated the dual-energy CT images and classifi ed the examination findings as positive or negative for the presence of uric acid crystals. Reference standard was the result of joint aspiration. Results: Forty-three of 94 patients (46{\%}) underwent attempted joint aspiration within 1 month of dual-energy CT. Aspiration was successful in 31 of 43 patients (72{\%}). In 12 of 31 patients (39{\%}), uric acid crystals were identified at joint aspiration; in 19 patients, they were not. Readers 1 and 2 had no false-negative findings for uric acid at dual-energy CT. Sensitivity was 100{\%} (12 of 12; 95{\%} confidence interval (CI): 74{\%}, 100{\%}) for both readers. Specificity was 89{\%} (17 of 19; 95{\%} CI: 67{\%}, 99{\%} ) for reader 1 and 79{\%} (15 of 19; 95{\%} CI: 54{\%}, 94{\%}) for reader 2, with nearperfect agreement between the readers(κ = 0.87; range, 0.70-1.00) in the 31 patients who underwent aspiration. Conclusion: 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.",
author = "Glazebrook, {Katrina Nesta} and Guimar{\~a}es, {Luis S.} and Murthy, {Naveen S} and David Black and Tim Bongartz and Manek, {Nisha J.} and Shuai Leng and Fletcher, {Joel Garland} and McCollough, {Cynthia H}",
year = "2011",
month = "11",
doi = "10.1148/radiol.11102485",
language = "English (US)",
volume = "261",
pages = "516--524",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
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TY - JOUR

T1 - Identification of intraarticular and periarticular uric acid crystals with dual-energy CT

T2 - Initial evaluation

AU - Glazebrook, Katrina Nesta

AU - Guimarães, Luis S.

AU - Murthy, Naveen S

AU - Black, David

AU - Bongartz, Tim

AU - Manek, Nisha J.

AU - Leng, Shuai

AU - Fletcher, Joel Garland

AU - McCollough, Cynthia H

PY - 2011/11

Y1 - 2011/11

N2 - Purpose: To estimate the accuracy, sensitivity, specificity, and interobserver agreement of dual-energy computed tomography (CT) in detection of uric acid crystals in joints or periarticular structures in patients with arthralgia and patients suspected of having gout, with joint aspiration results as reference standard . Materials and Methods: With institutional review board approval, patient consent, and HIPAA compliance, 94 patients (age range, 29-89 years) underwent dual-source, dual-energy (80 and 140 kVp) CT of a painful joint. A material decomposition algorithm was used to identify uric acid. Two blinded musculoskeletal radiologists evaluated the dual-energy CT images and classifi ed the examination findings as positive or negative for the presence of uric acid crystals. Reference standard was the result of joint aspiration. Results: Forty-three of 94 patients (46%) underwent attempted joint aspiration within 1 month of dual-energy CT. Aspiration was successful in 31 of 43 patients (72%). In 12 of 31 patients (39%), uric acid crystals were identified at joint aspiration; in 19 patients, they were not. Readers 1 and 2 had no false-negative findings for uric acid at dual-energy CT. Sensitivity was 100% (12 of 12; 95% confidence interval (CI): 74%, 100%) for both readers. Specificity was 89% (17 of 19; 95% CI: 67%, 99% ) for reader 1 and 79% (15 of 19; 95% CI: 54%, 94%) for reader 2, with nearperfect agreement between the readers(κ = 0.87; range, 0.70-1.00) in the 31 patients who underwent aspiration. Conclusion: 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.

AB - Purpose: To estimate the accuracy, sensitivity, specificity, and interobserver agreement of dual-energy computed tomography (CT) in detection of uric acid crystals in joints or periarticular structures in patients with arthralgia and patients suspected of having gout, with joint aspiration results as reference standard . Materials and Methods: With institutional review board approval, patient consent, and HIPAA compliance, 94 patients (age range, 29-89 years) underwent dual-source, dual-energy (80 and 140 kVp) CT of a painful joint. A material decomposition algorithm was used to identify uric acid. Two blinded musculoskeletal radiologists evaluated the dual-energy CT images and classifi ed the examination findings as positive or negative for the presence of uric acid crystals. Reference standard was the result of joint aspiration. Results: Forty-three of 94 patients (46%) underwent attempted joint aspiration within 1 month of dual-energy CT. Aspiration was successful in 31 of 43 patients (72%). In 12 of 31 patients (39%), uric acid crystals were identified at joint aspiration; in 19 patients, they were not. Readers 1 and 2 had no false-negative findings for uric acid at dual-energy CT. Sensitivity was 100% (12 of 12; 95% confidence interval (CI): 74%, 100%) for both readers. Specificity was 89% (17 of 19; 95% CI: 67%, 99% ) for reader 1 and 79% (15 of 19; 95% CI: 54%, 94%) for reader 2, with nearperfect agreement between the readers(κ = 0.87; range, 0.70-1.00) in the 31 patients who underwent aspiration. Conclusion: 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.

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