Division of Rheumatology, Department of Internal Medicine, Seoul Veterans Hospital, 53 Jinhwangdo-ro 61-gil Gangdong-gu, Seoul, 05368, South Korea.
Adv Rheumatol. 2021 Jun 29;61(1):40. doi: 10.1186/s42358-021-00198-0.
To investigate the frequency of monosodium urate (MSU) crystal deposits on dual-energy computed tomography (DECT) in patients with clinical diagnosis of gout and the factors associated MSU crystal positivity.
This study was conducted in patients with clinical diagnosis of gout who underwent DECT. Clinical features were compared between patients with positive and those with negative DECT results. A logistic regression analysis was performed to determine the factors associated with MSU crystal positivity on DECT.
A total of 148 patients with clinical diagnosis of gout were included, and MSU crystal deposition on DECT was observed in 64 patients (43.3%). The patients with positive DECT results were more likely to have renal insufficiency, longer disease duration, and higher serum urate level than those with negative. In the multivariable analysis, first gout attack (odds ratio 0.462; 95% confidence interval 0.229-0.931, p = 0.031) was associated with a less likely MSU crystal deposit-positive DECT result. In the subgroup analysis of patients with first attack, serum urate level > 8 mg/dL was associated with DECT positivity.
Of the patients with clinical diagnosis of gout, those with renal insufficiency, longer disease duration, and high serum urate level were more likely to be positive of gout on DECT. First gout attack was associated with less likely to be positive for MSU crystal on DECT. Thus, performing DECT scan in the selected patients who had characteristics that highly probability of DECT positivity could increase positive predictive value.
探讨临床诊断为痛风的患者在双能 CT（DECT）上尿酸单钠（MSU）晶体沉积的频率以及与 MSU 晶体阳性相关的因素。
本研究纳入了临床诊断为痛风且接受 DECT 检查的患者。比较了 DECT 结果阳性和阴性患者的临床特征。采用逻辑回归分析确定与 DECT 上 MSU 晶体阳性相关的因素。
共纳入 148 例临床诊断为痛风的患者，其中 64 例（43.3%）在 DECT 上观察到 MSU 晶体沉积。与 DECT 结果阴性的患者相比，DECT 结果阳性的患者更可能存在肾功能不全、更长的病程和更高的血清尿酸水平。多变量分析显示，首次痛风发作（比值比 0.462；95%置信区间 0.229-0.931，p=0.031）与更不可能出现 MSU 晶体沉积阳性的 DECT 结果相关。在首次发作患者的亚组分析中，血清尿酸水平＞8mg/dL 与 DECT 阳性相关。
在临床诊断为痛风的患者中，存在肾功能不全、更长的病程和更高的血清尿酸水平的患者在 DECT 上更可能出现痛风阳性。首次痛风发作与 DECT 上 MSU 晶体阳性的可能性较小相关。因此，对具有高度 DECT 阳性可能性特征的选定患者进行 DECT 扫描可以提高阳性预测值。
