Role of dual-energy CT in the diagnosis and follow-up of gout: systematic analysis of the literature |
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Authors: | André Ramon Amélie Bohm-Sigrand Pierre Pottecher Pascal Richette Jean-Francis Maillefert Herve Devilliers Paul Ornetti |
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Affiliation: | 1.Department of Rheumatology,Dijon University Hospital,Dijon,France;2.Department of Radiology, Section of Musculoskeletal Imaging and Intervention,Dijon University Hospital,Dijon,France;3.LE2I UMR CNRS 6306, Arts et Métiers,University of Burgundy,Dijon,France;4.INSERM U1132 and University Paris-Diderot,Paris,France;5.Department of Rheumatology,Hopital Lariboisiere,Paris,France;6.INSERM UMR1093-CAPS, Bourgogne Franche-Comté University,Dijon,France;7.Department of Internal Medicine,Dijon University Hospital,Dijon,France;8.CIC INSERM 1432, Centre Hospitalier Universitaire de Dijon,Dijon,France |
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Abstract: | The aim of this systematic review was to determine the potential role of dual-energy CT in the diagnosis and follow-up of gout with regard to the Outcome Measures in Rheumatology (OMERACT) filter. A systematic analysis of the literature was conducted using the MEDLINE and Cochrane databases and published abstracts of international congresses, according to the criteria of the OMERACT filter: feasibility, reproducibility, validity versus laboratory (serum urate, MSU synovial fluid aspirate) and other imaging modalities for gout, and its sensitivity to change in patients on urate lowering therapy (ULT). Thirty-two articles were found representing a total of 1502 patients. The data on feasibility showed that the examination took little time and involved low levels of radiation but had current limited availability. Intra- and inter-observer reproducibility was excellent, with intra-class correlation coefficients >?0.9. Validity in comparison with polarized-light microscopy showed good sensitivity and specificity (>?80%). The diagnostic performance was better than that of radiography and conventional CT-scan and at least equivalent to that of ultrasonography. The sensitivity to change varied with effect sizes from 0.05 (low) to 1.24 (high) for decrease in the tophus volume following different ULT in gout patients. Dual-energy CT-scan is a reproducible and accurate imaging modality for the diagnosis of gout, particularly for tophaceous gout (intra- or extra-articular). It can become a second-line imaging modality of choice in cases of diagnostic doubt, such as ultrasonography. Its role remains uncertain in the follow-up of gout patients treated with ULT and needs further clarification. |
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