Sotniczuk Maria, Nowakowska-Płaza Anna, Wroński Jakub, Wisłowska Małgorzata, Sudoł-Szopińska Iwona
Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland.
Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland.
J Clin Med. 2022 Sep 5;11(17):5249. doi: 10.3390/jcm11175249.
Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were retrospectively enrolled. The sensitivity and specificity of DECT alone, American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria without DECT, and ACR/EULAR criteria with DECT were assessed. Additionally, an analysis of gout risk factors was performed. When artifacts were excluded, any MSU volume provided the best diagnostic value of DECT (AUC = 0.872, 95% CI 0.806−0.938). DECT alone had a sensitivity of 90.4% and specificity of 74.5%. Although ACR/EULAR criteria without DECT provided better diagnostic accuracy than DECT alone (AUC = 0.926, 95% CI 0.878−0.974), the best value was obtained when combing both (AUC = 0.957, 95% CI 0.924−0.991), with 100% sensitivity and 76.6% specificity. In univariate analysis, risk factors for gout were male sex, presence of tophi, presence of MSU deposits on DECT, increased uric acid in serum (each p < 0.001), and decreased glomerular filtration rate (GFR) (p = 0.029). After logistic regression, only increased serum uric acid (p = 0.034) and decreased GFR (p = 0.018) remained independent risk factors for gout. Our results suggest that DECT significantly increases the sensitivity of the ACR/EULAR criteria in the diagnosis of gout.
双能计算机断层扫描（DECT）是一种检测尿酸钠（MSU）沉积的成像技术。本研究旨在评估DECT在痛风诊断中的临床应用价值。回顾性纳入了120例临床怀疑痛风且接受了DECT检查的患者。评估了单纯DECT、未使用DECT的美国风湿病学会（ACR）/欧洲风湿病联盟（EULAR）分类标准以及使用DECT的ACR/EULAR标准的敏感性和特异性。此外，还进行了痛风危险因素分析。排除伪影后，任何MSU体积的DECT诊断价值最佳（AUC = 0.872，95%CI 0.806−0.938）。单纯DECT的敏感性为90.4%，特异性为74.5%。虽然未使用DECT的ACR/EULAR标准比单纯DECT具有更高的诊断准确性（AUC = 0.926，95%CI 0.878−0.974），但两者结合时诊断价值最佳（AUC = 0.957，95%CI 0.924−0.991），敏感性为100%，特异性为76.6%。单因素分析中，痛风的危险因素包括男性、有痛风石、DECT显示有MSU沉积、血清尿酸升高（各p < 0.001）以及肾小球滤过率（GFR）降低（p = 0.029）。经逻辑回归分析后，仅血清尿酸升高（p = 0.034）和GFR降低（p = 0.018）仍是痛风的独立危险因素。我们的结果表明，DECT显著提高了ACR/EULAR标准在痛风诊断中的敏感性。
