Metzger Sarah C, Koehm Michaela, Wichmann Julian L, Buettner Stefan, Scholtz Jan-Erik, Beeres Martin, Kerl J Matthias, Albrecht Moritz H, Hammerstingl Renate, Vogl Thomas J, Bauer Ralf W
Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany.
Department of Rheumatology, Clinic of the Goethe University, Frankfurt.
Acad Radiol. 2016 Mar;23(3):267-72. doi: 10.1016/j.acra.2015.10.019. Epub 2015 Dec 31.
This investigation aimed to evaluate the impact on treatment regimen and clinical outcome of dual-energy computed tomography (DECT) in patients with suspected gouty arthritis.
We retrospectively analyzed electronic medical records (EMR) of 39 patients (36 male, 3 female; age range, 36-85 years) who underwent DECT of peripheral joints because of suspected gouty arthritis. We assessed the prior medical history, lab results, treatment regimen, and medications before and after DECT, and changes in subjective severity of symptoms as stated by patients in the EMR. The presence of monosodium urate (MSU) crystals in the index joint was verified with DECT.
Several patients had a prior diagnosis of gout (n = 9), hyperuricemia (n = 6), rheumatoid arthritis (n = 3), or psoriatic arthritis (n = 3). Elevated uric acid blood levels were detected in 32 patients (82%) before DECT. On DECT, MSU crystals were detected in 23 patients (59%). Of the 36 cases, the current treatment regimen was modified after DECT to gout-specific therapy in 22 cases and other rheumatic diseases were targeted in 14 cases. Several medications were prescribed more frequently based after DECT compared to before DECT imaging, including steroids (n = 20 vs. n = 12, respectively), colchicine (n = 13 vs. n = 4, respectively), and urate-lowering medication (n = 18 vs. n = 11, respectively). A subjective reduction of clinical symptoms during cumulative follow-up was reported by 34 patients (87.2%).
Both positive and negative findings of MSU crystals on DECT have a significant impact on the treatment regimen and clinical outcome of patients with suspected gouty arthritis and facilitate differentiation from other rheumatic diseases.
本研究旨在评估双能计算机断层扫描（DECT）对疑似痛风性关节炎患者治疗方案及临床结局的影响。
我们回顾性分析了39例因疑似痛风性关节炎接受外周关节DECT检查患者（36例男性，3例女性；年龄范围36 - 85岁）的电子病历（EMR）。我们评估了患者的既往病史、实验室检查结果、治疗方案以及DECT检查前后的用药情况，以及EMR中患者自述症状主观严重程度的变化。通过DECT确认了索引关节中尿酸钠（MSU）晶体的存在。
部分患者既往诊断为痛风（n = 9）、高尿酸血症（n = 6）、类风湿关节炎（n = 3）或银屑病关节炎（n = 3）。DECT检查前，32例患者（82%）血尿酸水平升高。在DECT检查中，23例患者（59%）检测到MSU晶体。在36例患者中，DECT检查后，22例患者的当前治疗方案改为针对痛风的特异性治疗，14例患者针对其他风湿性疾病进行治疗。与DECT成像前相比，DECT检查后几种药物的处方频率更高，包括类固醇（分别为n = 20和n = 12）、秋水仙碱（分别为n = 13和n = 4）以及降尿酸药物（分别为n = 18和n = 11）。34例患者（87.2%）报告在累积随访期间临床症状主观减轻。
DECT上MSU晶体的阳性和阴性结果对疑似痛风性关节炎患者的治疗方案和临床结局均有显著影响，并有助于与其他风湿性疾病相鉴别。
