Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value?
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SCIENTIFIC ARTICLE
Dual-energy CT in the differentiation of crystal depositions of the wrist: does it have added value? Katharina Ziegeler 1
&
Sandra Hermann 2 & Kay Geert A. Hermann 1 & Bernd Hamm 1 & Torsten Diekhoff 1
Received: 3 September 2019 / Revised: 6 November 2019 / Accepted: 7 November 2019 # ISS 2019
Abstract Objectives To evaluate the ability of dual-energy computed tomography (DECT) to improve diagnostic discrimination between gout and other crystal arthropathies such as calcium pyrophosphate deposition disease (CPPD) of the wrist in a clinical patient population. Materials and methods This retrospective case-control study included 29 patients with either gout (case group; n = 9) or CPPD (control group; n = 20) who underwent DECT of the wrist for clinically suspected crystal arthropathy. Color-coded urate and enhanced calcium as well as virtual 120 kVe blended images were reconstructed from the DECT datasets. Two independent and blinded readers evaluated each reconstructed dataset for the presence of depositions in 17 predefined regions. Additionally, a global diagnosis was made first for 120 kVe images only, based solely on morphologic criteria, and subsequently for all reconstructed images. Results Sensitivity for the global diagnosis of gout was 1.0 (95% CI 0.63–1) for both DECT and 120 kVe images with specificities of 0.70 (95% CI 0.46–0.87) for DECT and 0.80 (95% CI 0.56–0.93) for 120 kVe images. Color-coded DECT images did not detect more depositions than monochrome standard CT images. Conclusion Discrimination of crystal arthropathies of the wrist is limited using DECT and primarily relying on color-coded images. Evaluation of morphologic criteria on standard CT images is essential for accurate diagnosis. Keywords Gout . Chondrocalcinosis . Wrist . Dual-energy computed tomography . Diagnostic imaging
Introduction Gout is an inflammatory arthritis that develops in response to the deposition of monosodium urate (MSU) crystals in articular and periarticular tissues. With an estimated prevalence of 0.9–2.5% in central Europe, the burden of gout is high [1, 2]. The diagnostic standard of reference is the identification of MSU crystals in synovial fluid of an affected joint [3]. However, this method is invasive and has been Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00256-019-03343-5) contains supplementary material, which is available to authorized users. * Katharina Ziegeler [email protected] 1
Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
2
Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
shown to have limited accuracy, with a false-negative rate of up to 25% [4]. For early diagnosis of gout, imaging tools with high diagnostic accuracy are needed to detect initial abnormalities. An imaging tool which has gained increasing attention in recent years is dual-energy computed tomography (DECT) because it detects MSU based on its characteristic
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