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01-11-2016 | Computed Tomography

Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT

Authors: Tim Finkenstaedt, Andrei Manoliou, Martin Toniolo, Kai Higashigaito, Gustav Andreisek, Roman Guggenberger, Beat Michel, Hatem Alkadhi

Published in: European Radiology | Issue 11/2016

Abstract

Objectives

To determine the diagnostic and therapeutic impact of dual-energy computed tomography (DECT) in gout.

Methods

Forty-three patients with (n = 20) and without a history of gout (n = 23) showing non-specific soft tissue deposits underwent DECT after unrewarding arthrocentesis. Two blinded, independent readers evaluated DECT for the presence of urate crystals. Clinical diagnosis, clinically suspected urate crystal locations, diagnostic thinking and therapeutic decisions were noted before and after DECT. Clinical 1-month follow-up was obtained.

Results

DECT showed urate in 26/43 patients (60 %). After DECT, clinical diagnosis of gout was withdrawn in 17/43 (40 %) and was maintained in 16/43 patients (37 %). In 10/43 patients (23 %) the diagnosis was maintained, but DECT revealed urate in clinically unsuspected locations. In 23/43 patients (53 %), a treatment-change based on DECT occurred. Changes in diagnostic thinking occurred more frequently in patients without a history of gout (p < 0.001), changes in therapeutic decisions more frequently in patients with a history of gout (p = 0.014). Clinical follow-up indicated beneficial effects of DECT-based diagnoses in 83 % of patients.

Conclusions

In patients with or without a history of gout and a recent suspicion for gouty arthritis with an unrewarding arthrocentesis, DECT has a marked diagnostic and therapeutic impact when hyperdense soft-tissue deposits are present.

Key Points

• This study evaluates the concept of evidence-based radiology

• In patients with suspected gout, DECT can help clinicians make the diagnosis

• DECT has a marked impact on therapy

• Clinical follow-up after 1 month indicated reliable results of DECT

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Title: Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT
Authors: Tim Finkenstaedt
Andrei Manoliou
Martin Toniolo
Kai Higashigaito
Gustav Andreisek
Roman Guggenberger
Beat Michel
Hatem Alkadhi
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 11/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4237-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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