Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
Department of Radiology, Dongguk University Ilsan Hospital, Gyenggi-do, 10326, Republic of Korea.
Eur Radiol. 2019 Mar;29(3):1267-1275. doi: 10.1007/s00330-018-5716-4. Epub 2018 Sep 17.
To determine the incremental value of non-contrast CT (NCCT) on dual-energy CT (DECT) in symptomatic first metatarsophalangeal (MTP) joints in early gout.
One hundred and fifteen painful joints were consecutively enrolled and gout was diagnosed based on the 2015 EULAR/ACR criteria and/or arthrocentesis. Two readers independently evaluated DECT alone and combined NCCT and DECT (NCCT+DECT) based on four semiquantitative scales. Sensitivities and specificities were compared using McNemar's test. AUC was compared.
Of the 115 joints, 72 were defined as an early gout group and 43 as a gout-negative group after exclusion. The sensitivity and specificity for the early gout group on DECT alone were as followed: reader 1 - 52.8% and 100.0% and reader 2 - 51.4% and 100.0%. NCCT+DECT results were as follows: reader 1 - 79.2% and 93.0% and reader 2 - 79.2% and 95.3%. AUC was significantly higher in NCCT+DECT compared to that in DECT alone for the early gout group (0.888 vs. 0.774 for reader 1, p = 0.0004; 0.896 vs. 0.816 for reader 2, p = 0.0142). The false-negative cases on DECT occurred more frequently with the first-onset gout, and tended to be affected by a longer duration of symptoms in the post-hoc analysis.
The combined analysis of NCCT and DECT improves diagnostic capabilities in symptomatic early gout involving the first MTP joint.
• MSU crystal depositions in early gout may be seen on non-contrast CT, while still being undetectable by DECT. • Combining non-contrast CT and DECT improves detection of early gout. • False negatives of DECT are more common than previously reported in cases of first-onset gout.
在早期痛风的第一跖趾（MTP）关节的症状性关节中，确定非对比 CT（NCCT）在双能 CT（DECT）上的增量价值。
连续纳入 115 个疼痛关节，根据 2015 年 EULAR/ACR 标准和/或关节穿刺术诊断为痛风。两位读者分别基于四个半定量评分独立评估 DECT 单独和 NCCT+DECT（NCCT+DECT）。使用 McNemar 检验比较敏感性和特异性。比较 AUC。
在排除后，115 个关节中 72 个被定义为早期痛风组，43 个为痛风阴性组。DECT 单独用于早期痛风组的敏感性和特异性如下：读者 1-52.8%和 100.0%和读者 2-51.4%和 100.0%。NCCT+DECT 的结果如下：读者 1-79.2%和 93.0%和读者 2-79.2%和 95.3%。对于早期痛风组，NCCT+DECT 的 AUC 明显高于 DECT 单独（对于读者 1，0.888 与 0.774，p=0.0004；对于读者 2，0.896 与 0.816，p=0.0142）。在后验分析中，DECT 的假阴性病例在首次痛风发作时更常见，并且往往受到症状持续时间更长的影响。
NCCT 和 DECT 的联合分析提高了第一 MTP 关节症状性早期痛风的诊断能力。
• MSU 晶体沉积在早期痛风中可能在非对比 CT 上可见，而在 DECT 上仍不可检测。• 结合非对比 CT 和 DECT 可提高早期痛风的检出率。• 在首次发作的痛风中，DECT 的假阴性比以前报道的更常见。
