Gout of ankle and foot: DECT versus US for crystal detection
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ORIGINAL ARTICLE
Gout of ankle and foot: DECT versus US for crystal detection Zhengping Zou 1 & Mingfeng Yang 2 & Yiwen Wang 2 & Bin Zhang 2 Received: 5 July 2020 / Revised: 23 August 2020 / Accepted: 27 August 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objective To compare dual-energy computed tomography (DECT) and ultrasound (US) in detecting monosodium urate (MSU) crystals in the ankle and foot in patients with acute gouty arthritis. Methods Bilateral ankle and foot were examined by DECT and US and the differences between the findings were compared. Results A total of 50 patients underwent DECT and US examinations. At the patient level, the overall positivity of crystal deposition detected by DECT was higher than that by US (92% vs 68%, P = 0.005). The agreement of detecting crystal deposition between DECT and US was not very strong (К = 0.44, P = 0.003). At different joint/area levels, there were significant differences between the two examinations in the area of the dorsum (36% vs 12%, P = 0.009) and metatarsal bone (34% vs 12%, P = 0.017), but the sensitivity of DECT and US was similar in the first metatarsophalangeal joint (MTP) and ankle areas (P>0.05). Agreement between the two examinations in the ankle and first MTP was very strong (К = 0.86, P < 0.001; К = 0.79, P < 0.001, respectively). However, agreement between the two examinations in other joints/areas was poor. Conclusion These findings indicated that DECT should be the first choice for acute gouty arthritis in patients with ankle and foot involvement. Key Points • There is little data regarding DECT and US in detecting MSU crystals in the ankle and foot in patients with acute gouty arthritis. • The overall positivity of crystal deposition detected by DECT was higher than that by US, but the sensitivity of DECT and US was similar in the first metatarsophalangeal joint (MTP) and ankle areas. • Agreement between the two examinations in the ankle and first MTP was very strong; however, agreement between the two examinations in other joints/areas was poor.
Keywords Acute gouty arthritis . Ankle . Dual-energy computed tomography (DECT) . Foot . Monosodium urate (MSU) crystals . Ultrasound (US)
Introduction Gout is the most common inflammatory arthritis that develops after a history of hyperuricemia and subsequent monosodium urate (MSU) crystal deposition within joints and soft tissues [1]. Traditionally, the gold standard for gout diagnosis has
* Bin Zhang [email protected] 1
Department of Rheumatology and Nephrology, Qianjiang Central Hospital, Qianjiang Clinical Medical College of Yangtze University, Qianjiang 433100, Hubei, China
2
Department of Rheumatology, Affiliated Hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing 314000, Zhejiang, China
been microscopic confirmation of MSU crystals [2, 3]. However, that is not always possible because of synovial fluid aspiration which is invasive and usually the difficulty of assessing small joints that may be affected by the disease. In recent ye
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