Lacaita Pietro G, Klauser Andrea S, Held Julia, Haschka David, Widmann Gerlig, Feuchtner Gudrun M
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.
Eur Radiol Exp. 2025 Aug 11;9(1):73. doi: 10.1186/s41747-025-00611-z.
Dual-energy computed tomography (DECT) detects monosodium urate (MSU) deposits in joints. However, the correlation between coronary atherosclerosis phenotypes and MSU-positive lesions in the cardiovascular system remains unclear. We investigated the correlation between coronary MSU-positive plaques on unenhanced DECT with the coronary atherosclerosis profile at coronary CT angiography.
One hundred fifty rheumatologic patients were prospectively enrolled. Sixty of them underwent unenhanced DECT and 128-row DECT coronary angiography. Analysis included CAD-RADS stenosis severity, high-risk plaque (HRP) phenotypes, and coronary artery calcium (CAC) score.
Of 60 patients, with a mean age of 63.7 years, including 7 females (11.7%), 37 had gout (61.7%), 9 had hyperuricemia (15%), and 14 had other rheumatologic diseases (23.3%). At DECT, 11 (18.3%) had coronary MSU-positive lesions totaling 24 lesions (left anterior descending, 12; right coronary artery, 10; circumflex, 1; left main, 1). HRP phenotypes were identified in 14 of 60 patients (23.3%). The prevalence of HRP was higher in MSU-positive than MSU-negative patients (63.3% versus 14.2%; p = 0.003; odds ratio 9.91; 95% confidence interval [CI]: 2.30-48.41). CAD-RADS and CAC scores correlated with the number of MSU-positive lesions (ρ = 0.412; 95% CI: 0.167-0.609; p < 0.001) and ρ = 0.412; 95% CI: 0.169-0.609; p < 0.001). None of the major cardiovascular risk factors (smoking, hypertension, dyslipidemia, or diabetes) was associated with MSU-positive lesions.
We found an association between coronary MSU-positive lesions and HRP-phenotypes, as well as a correlation with stenosis severity and calcium burden. MSU-positive lesions may serve as an unenhanced DECT-derived biomarker of increased cardiovascular risk.
The detection of coronary MSU-positive lesions by DECT could indicate an increased likelihood of HRP phenotypes. These findings suggest their potential as imaging biomarkers for cardiovascular risk, using unenhanced spectral DECT scans or photon-counting CT.
Identifying gout patients with increased cardiovascular risk remains challenging. Coronary MSU-positive lesions detected on unenhanced DECT may be associated with HRP features on coronary computed tomography angiography. MSU-positive lesions could serve as biomarkers for cardiovascular risk in gout patients.
双能计算机断层扫描（DECT）可检测关节中的尿酸钠（MSU）沉积。然而，心血管系统中冠状动脉粥样硬化表型与MSU阳性病变之间的相关性仍不清楚。我们研究了未增强DECT上冠状动脉MSU阳性斑块与冠状动脉CT血管造影时冠状动脉粥样硬化特征之间的相关性。
前瞻性纳入150例风湿病患者。其中60例接受了未增强DECT和128排DECT冠状动脉造影。分析包括CAD-RADS狭窄严重程度、高危斑块（HRP）表型和冠状动脉钙化（CAC）评分。
60例患者的平均年龄为63.7岁，其中女性7例（11.7%），痛风患者37例（61.7%），高尿酸血症患者9例（15%），其他风湿病患者14例（23.3%）。在DECT检查中，11例（18.3%）有冠状动脉MSU阳性病变，共24个病变（左前降支12个；右冠状动脉10个；回旋支1个；左主干1个）。60例患者中有14例（23.3%）识别出HRP表型。MSU阳性患者中HRP的患病率高于MSU阴性患者（63.3%对14.2%；p = 0.003；优势比9.91；95%置信区间[CI]：2.30 - 48.41）。CAD-RADS和CAC评分与MSU阳性病变数量相关（ρ = 0.412；95% CI：0.167 - 0.609；p < 0.001）和ρ = 0.412；95% CI：0.169 - 0.609；p < 0.001）。主要心血管危险因素（吸烟、高血压、血脂异常或糖尿病）均与MSU阳性病变无关。
我们发现冠状动脉MSU阳性病变与HRP表型之间存在关联，并且与狭窄严重程度和钙化负荷相关。MSU阳性病变可能作为未增强DECT衍生的心血管风险增加的生物标志物。
通过DECT检测冠状动脉MSU阳性病变可能表明HRP表型的可能性增加。这些发现表明它们作为使用未增强光谱DECT扫描或光子计数CT的心血管风险成像生物标志物的潜力。
识别心血管风险增加的痛风患者仍然具有挑战性。在未增强DECT上检测到的冠状动脉MSU阳性病变可能与冠状动脉计算机断层扫描血管造影上的HRP特征相关。MSU阳性病变可作为痛风患者心血管风险的生物标志物。
