Skip to main content
Log in

Gout: Update on Dual-Energy Computed Tomography with Emphasis on Artifact Identification

  • Imaging (D Mintz, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Gout is the most common inflammatory arthritis and is increasing in prevalence and incidence in many countries worldwide. Accurate diagnosis is important to direct treatment that may include chronic medication. Burden quantification and treatment monitoring are key in the effective care of patients with gout. This review highlights the positive impact of dual-energy computed tomography (DECT) on the evaluation of gout patients and discusses common imaging artifacts that limit this imaging modality.

Recent Findings

DECT has become the most accurate imaging method for confirming or excluding gout. Of note, however, it has reduced sensitivity in early disease, including initial attacks. Burden quantification is another important role of DECT, which can now be performed using automated software methods, allowing for a more reliable assessment of treatment effect. However, the analysis of gout DECT images can be impeded by artifacts related to the DECT reconstruction technique.

Summary

DECT is the most sensitive and specific imaging modality for diagnosis, burden quantification, and treatment monitoring in patients with gout. A working knowledge of common DECT artifacts is essential for mitigating their occurance and misinterpretation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Richette P, Bardin T. Gout. Lancet. 2010;375(9711):318–28.

    Article  CAS  Google Scholar 

  2. http://www.academia.edu/3653849/Catfish_Remedy_for_Gout_in_Ancient_Egypt, accessed November 13, 2017.

  3. Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet. 2016;388(10055):2039–52.

    Article  CAS  Google Scholar 

  4. Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol. 2015;11(11):649–62.

    Article  Google Scholar 

  5. Thottam GE, Svetlana Krasnokutsky S, Pillinger MH. Gout and metabolic syndrome: a tangled web. Curr Rheumatol Rep. 2017;19(10):60.

    Article  Google Scholar 

  6. •• Neogi T, Jansen TL, Dalbeth N, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015;67(10):2557–68 This collaborative initiative provided new evidence-based classification criteria for the diagnosis of gout that now incorporates DECT in the diagnostic algorithm.

    Article  Google Scholar 

  7. Araujo EG, Bayat S, Petsch C, et al. Tophus resolution with pegloticase: a prospective dual-energy CT study. RMD Open. 2015;1(1):e000075.

    Article  Google Scholar 

  8. Modjinou DV, Krasnokutsky S, Gyftopoulos S, Pike VC, Karis E, Keenan RT, et al. Comparison of dual-energy CT, ultrasound and surface measurement for assessing tophus dissolution during rapid urate debulking. Clin Rheumatol. 2017;36(9):2101–7.

    Article  Google Scholar 

  9. Pascart T, Grandjean A, Norberciak L, Ducoulombier V, Motte M, Luraschi H, et al. Ultrasonography and dual-energy computed tomography provide different quantification of urate burden in gout: results from a cross-sectional study. Arthritis Res Ther. 2017;19(1):171.

    Article  Google Scholar 

  10. Choi HK, Mount DB, Reginato AM. Pathogenesis of gout. Ann Intern Med. 2005;143:499–516.

    Article  CAS  Google Scholar 

  11. Ragab G, Elshahaly M, Bardin T. Gout: an old disease in new perspective—a review. J Adv Res. 2017 Sep;8(5):495–511.

    Article  CAS  Google Scholar 

  12. Perez-Ruiz F, Castillo E, Chinchilla SP, Herrero-Beites AM. Clinical manifestations and diagnosis of gout. Rheum Dis Clin N Am. 2014;40:193–206.

    Article  Google Scholar 

  13. • Lee YH, Song GG. Diagnostic accuracy of dual-energy computed tomography in patients with gout: a meta-analysis. Semin Arthritis Rheum. 2017;47(1):95–101 This meta-analysis showed that DECT is highly accurate in the diagnosis of gout with high sensitivity and high specificity.

    Article  Google Scholar 

  14. Bongartz T, Glazebrook KN, Kavros SJ, Murthy NS, Merry SP, Franz WB III, et al. Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. Ann Rheum Dis. 2015;74:1072–7.

    Article  CAS  Google Scholar 

  15. Jia E, Zhu J, Huang W, Chen X, Li J. Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout. Clin Rheumatol. 2018;37(3):773–7.

    Article  Google Scholar 

  16. Dalbeth N, House ME, Aati O, Tan P, Franklin C, Horne A, et al. Urate crystal deposition in asymptomatichyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis. 2015;74:908–11.

    Article  Google Scholar 

  17. Glazebrook KN, Kakar S, Ida CM, Laurini JA, Moder KG, Leng S. False-negative dual-energy computed tomography in a patient with acute gout. J Clin Rheumatol. 2012;18:138–41.

    Article  Google Scholar 

  18. Baer AN, Kurano T, Thakur UJ, et al. Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout. BMC Musculoskelet Disord. 2016 Feb 18;17:91.

    Article  Google Scholar 

  19. Choi HK, Al-Arfaj AM, Eftekhari A, et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis. 2009;68:1609–12.

    Article  CAS  Google Scholar 

  20. Glazebrook KN, Guimarães LS, Murthy NS, Black DF, Bongartz T, J. Manek N, et al. Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology. 2011 Nov;261(2):516–24.

    Article  Google Scholar 

  21. •• Grainger R, Dalbeth N, Keen H, et al. Imaging as an outcome measure in gout studies: report from the OMERACT Gout Working Group. J Rheumatol. 2015;42(12):2460–4 This group proposed the imaging modalities with the most potential for determining outcome in patient with gout and outlined important areas of future investigation.

    Article  Google Scholar 

  22. Rajan A, Aati O, Kalluru R, Gamble GD, Horne A, Doyle AJ, et al. Lack of change in urate deposition by dual-energy computed tomography among clinically stable patients with long-standing tophaceous gout: a prospective longitudinal study. Arthritis Res Ther. 2013;15(5):R160.

    Article  Google Scholar 

  23. • Mallinson PI, Coupal T, Reisinger C. Artifacts in dual-energy CT gout protocol: a review of 50 suspected cases with an artifact identification guide. AJR. 2014;203:W103–9 This group described various artifacts associated with DECT and outlined methods to reduce or correct them.

    Article  Google Scholar 

  24. Coupal TM, Mallinson PI, Gershony SL, McLaughlin PD, Munk PL, Nicolaou S, et al. Getting the most from your dual-energy scanner: recognizing, reducing, and eliminating artifacts. AJR Am J Roentgenol. 2016;206(1):119–28.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hillary W. Garner.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Imaging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garner, H.W., Wessell, D.E. Gout: Update on Dual-Energy Computed Tomography with Emphasis on Artifact Identification. Curr Rheumatol Rep 20, 86 (2018). https://doi.org/10.1007/s11926-018-0783-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-018-0783-8

Keywords

Navigation