Breuer Gabriel S, Bogot Naama, Nesher Gideon
Rheumatology Unit, Department of Medicine, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
Department of Radiology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
Int J Rheum Dis. 2016 Dec;19(12):1337-1341. doi: 10.1111/1756-185X.12938. Epub 2016 Jul 26.
The aim of this study is to evaluate the diagnostic yield of dual-energy computed tomography (DECT) in detection of uric acid accumulation in joints or periarticular structures in patients suspected of having gout, in their intercritical period.
Patients with a history of recurrent, short-lived mono- or oligo-arthralgia or arthritis, referred to the rheumatology clinic for diagnosis of their condition, were included in this retrospective evaluation.
DECT confirmed the diagnosis of gout in 30 of 50 patients (60%). A positive DECT was present in 12 of 16 cases (75%) with serum uric acid > 8.5 mg/dL, compared to seven of 13 cases (54%) and two of five cases (40%) with levels of 6.1-8.5 mg/dL and ≤ 6 mg/dL, respectively. The diagnostic impact of screening hands and feet were highest (78% and 56%, respectively). Follow-up data were available for 24 of the 30 patients with urate deposits identified by DECT. Twenty-one were treated with urate-lowering agents, all responded with lowering of serum uric acid and cessation of flares. Follow-up data were available for 16 of the 20 patients with no urate deposits identified by DECT. Gout was diagnosed in two of them by synovial fluid examination during subsequent flares. Both positive and negative predictive values of DECT for diagnosing gout in this patient population were 87%. Following DECT, treatment regimen was modified to gout-specific therapy in 52% of the patients.
The ability to make a definite diagnosis of gout by DECT imaging in a substantial number of asymptomatic patients in the intercritical period should help in treatment decision-making and improve patient adherence to long-term urate-lowering therapy.
本研究旨在评估双能计算机断层扫描（DECT）对疑似痛风患者在发作间期关节或关节周围结构中尿酸沉积的诊断效能。
本回顾性评估纳入了因反复短暂性单关节或寡关节炎就诊于风湿病门诊以明确病情的患者。
DECT确诊了50例患者中的30例（60%）痛风。血清尿酸>8.5mg/dL的16例患者中有12例（75%）DECT结果为阳性，相比之下，血清尿酸水平在6.1 - 8.5mg/dL的13例患者中有7例（54%），血清尿酸水平≤6mg/dL的5例患者中有2例（40%）DECT结果为阳性。筛查手部和足部时DECT的诊断影响最高（分别为78%和56%）。30例经DECT鉴定有尿酸盐沉积的患者中有24例有随访数据。21例接受了降尿酸药物治疗，所有患者血清尿酸均下降且发作停止。20例经DECT鉴定无尿酸盐沉积的患者中有16例有随访数据。其中2例在随后发作期间通过滑液检查被诊断为痛风。在该患者群体中，DECT诊断痛风的阳性和阴性预测值均为87%。DECT检查后，52%的患者治疗方案改为针对痛风的治疗。
在大量发作间期无症状患者中通过DECT成像明确诊断痛风的能力有助于治疗决策制定，并提高患者对长期降尿酸治疗的依从性。
