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Published in: European Radiology 1/2020

01-01-2020 | Computed Tomography | Computed Tomography

Development and validation of a quantitative method for estimation of the urate burden in patients with gouty arthritis using dual-energy computed tomography

Authors: Maximilian Kotlyarov, Kay Geert A. Hermann, Jürgen Mews, Bernd Hamm, Torsten Diekhoff

Published in: European Radiology | Issue 1/2020

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Abstract

Objectives

To develop a method that allows approximating the mass of monosodium uric acid (MSU) in a gouty tophus using phantom measurements and including tophus density into the calculation of the dual-energy computed tomography (DECT) tophus volumetry.

Methods

We prepared specimens of different concentrations of MSU placed in an epoxy-based phantom and an excised porcine foreleg. Density and volumetric measurements were performed in sequential single-source DECT scans acquired with increasingly higher tube currents. We developed a method for estimating the tophus mass by multiplying the detected tophus volume with its mean density and adding a specific gravimetric coefficient k. k was derived from the DECT scans by comparing the approximated MSU masses in the epoxy phantom with the known true MSU masses of the specimens.

Results

Comparison of the approximated MSU masses in the porcine foreleg scans with the true MSU masses of the syringe contents showed similar performance to sole volume measurement while providing additional information on the true uric acid burden: Over 70% of the true urate masses have been detected in MSU concentrations ≥ 45%, while the detection rate was much lower for MSU concentrations ≤ 40%. Retrospective analysis of patients with proven gouty arthritis confirmed the diagnostic potential of the mass approximation technique.

Conclusions

We successfully established a method to include tophus density measurement for estimation of the uric acid burden in milligrams (instead of ml) in a phantom setting for MSU concentrations above 40%. Future studies should validate its use for follow-up in clinical practice.

Key Points

• Including tophus density measurement in dual-energy computed tomography scans in a phantom setting can be used for estimating the urate burden in milligrams, which might be useful for imaging follow-up.
• The mass [mg] of the uric acid burden in a patient with gouty arthritis can be calculated by multiplying volume [ml] with mean density [HU] using a specific gravimetric coefficient.
• Retrospective analysis of two patients with gouty tophi showed the relevance of measuring urate mass in addition to urate volume alone.
Literature
1.
go back to reference Garner HW, Wessell DE (2018) Current status of ultrasound and dual-energy computed tomography in the evaluation of gout. Rheumatol Int 38:1339–1344CrossRef Garner HW, Wessell DE (2018) Current status of ultrasound and dual-energy computed tomography in the evaluation of gout. Rheumatol Int 38:1339–1344CrossRef
2.
go back to reference Lee YH, Song GG (2017) Diagnostic accuracy of dual-energy computed tomography in patients with gout: a meta-analysis. Semin Arthritis Rheum 47:95–101CrossRef Lee YH, Song GG (2017) Diagnostic accuracy of dual-energy computed tomography in patients with gout: a meta-analysis. Semin Arthritis Rheum 47:95–101CrossRef
3.
go back to reference Teh J, McQueen F, Eshed I, Plagou A, Klauser A (2018) Advanced imaging in the diagnosis of gout and other crystal arthropathies. Semin Musculoskelet Radiol 22:225–236CrossRef Teh J, McQueen F, Eshed I, Plagou A, Klauser A (2018) Advanced imaging in the diagnosis of gout and other crystal arthropathies. Semin Musculoskelet Radiol 22:225–236CrossRef
4.
go back to reference Finkenstaedt T, Manoliou A, Toniolo M et al (2016) Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT. Eur Radiol 26:3989–3999CrossRef Finkenstaedt T, Manoliou A, Toniolo M et al (2016) Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT. Eur Radiol 26:3989–3999CrossRef
5.
go back to reference Klauser AS, Halpern EJ, Strobl S et al (2018) Gout of hand and wrist: the value of US as compared with DECT. Eur Radiol 28:4174–4181CrossRef Klauser AS, Halpern EJ, Strobl S et al (2018) Gout of hand and wrist: the value of US as compared with DECT. Eur Radiol 28:4174–4181CrossRef
6.
go back to reference Johnson TR, Krauss B, Sedlmair M et al (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517CrossRef Johnson TR, Krauss B, Sedlmair M et al (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517CrossRef
7.
go back to reference Coupal TM, Mallinson PI, Gershony SL et al (2016) Getting the most from your dual-energy scanner: recognizing, reducing, and eliminating artifacts. AJR Am J Roentgenol 206:119–128CrossRef Coupal TM, Mallinson PI, Gershony SL et al (2016) Getting the most from your dual-energy scanner: recognizing, reducing, and eliminating artifacts. AJR Am J Roentgenol 206:119–128CrossRef
8.
go back to reference Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V (2016) Regulation of uric acid metabolism and excretion. Int J Cardiol 213:8–14CrossRef Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V (2016) Regulation of uric acid metabolism and excretion. Int J Cardiol 213:8–14CrossRef
9.
go back to reference Coursey CA, Nelson RC, Boll DT et al (2010) Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging? Radiographics 30:1037–1055CrossRef Coursey CA, Nelson RC, Boll DT et al (2010) Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging? Radiographics 30:1037–1055CrossRef
10.
go back to reference Moreno CC (2015) Dual-energy CT and its applications in the abdomen. In: Elsayes, KM (Eds) Cross-sectional imaging of the abdomen and pelvis. A practical algorithmic approach. Springer, New York, pp 1023–1033CrossRef Moreno CC (2015) Dual-energy CT and its applications in the abdomen. In: Elsayes, KM (Eds) Cross-sectional imaging of the abdomen and pelvis. A practical algorithmic approach. Springer, New York, pp 1023–1033CrossRef
11.
go back to reference Chou H, Chin TY, Peh WC (2017) Dual-energy CT in gout - a review of current concepts and applications. J Med Radiat Sci 64:41–51CrossRef Chou H, Chin TY, Peh WC (2017) Dual-energy CT in gout - a review of current concepts and applications. J Med Radiat Sci 64:41–51CrossRef
12.
go back to reference Nicolaou S, Yong-Hing CJ, Galea-Soler S, Hou DJ, Louis L, Munk P (2010) Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. AJR Am J Roentgenol 194:1072–1078CrossRef Nicolaou S, Yong-Hing CJ, Galea-Soler S, Hou DJ, Louis L, Munk P (2010) Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. AJR Am J Roentgenol 194:1072–1078CrossRef
13.
go back to reference Lee SK, Jung JY, Jee WH, Lee JJ, Park SH (2019) Combining non-contrast and dual-energy CT improves diagnosis of early gout. Eur Radiol 29:1267–1275CrossRef Lee SK, Jung JY, Jee WH, Lee JJ, Park SH (2019) Combining non-contrast and dual-energy CT improves diagnosis of early gout. Eur Radiol 29:1267–1275CrossRef
14.
go back to reference Diekhoff T, Kiefer T, Stroux A et al (2015) Detection and characterization of crystal suspensions using single-source dual-energy computed tomography: a phantom model of crystal arthropathies. Invest Radiol 50:255–260CrossRef Diekhoff T, Kiefer T, Stroux A et al (2015) Detection and characterization of crystal suspensions using single-source dual-energy computed tomography: a phantom model of crystal arthropathies. Invest Radiol 50:255–260CrossRef
15.
go back to reference Desai MA, Peterson JJ, Garner HW, Kransdorf MJ (2011) Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics 31:1365–1375CrossRef Desai MA, Peterson JJ, Garner HW, Kransdorf MJ (2011) Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics 31:1365–1375CrossRef
16.
go back to reference Zhang Z, Zhang X, Sun Y et al (2017) New urate depositions on dual-energy computed tomography in gouty arthritis during urate-lowering therapy. Rheumatol Int 37:1365–1372CrossRef Zhang Z, Zhang X, Sun Y et al (2017) New urate depositions on dual-energy computed tomography in gouty arthritis during urate-lowering therapy. Rheumatol Int 37:1365–1372CrossRef
17.
go back to reference Breuer GS, Bogot N, Nesher G (2016) Dual-energy computed tomography as a diagnostic tool for gout during intercritical periods. Int J Rheum Dis 19:1337–1341CrossRef Breuer GS, Bogot N, Nesher G (2016) Dual-energy computed tomography as a diagnostic tool for gout during intercritical periods. Int J Rheum Dis 19:1337–1341CrossRef
18.
go back to reference Diekhoff T, Kotlyarov M, Mews J, Hamm B, Hermann KGA (2018) Iterative reconstruction may improve diagnosis of gout: an ex vivo (bio)phantom dual-energy computed tomography study. Invest Radiol 53:6–12CrossRef Diekhoff T, Kotlyarov M, Mews J, Hamm B, Hermann KGA (2018) Iterative reconstruction may improve diagnosis of gout: an ex vivo (bio)phantom dual-energy computed tomography study. Invest Radiol 53:6–12CrossRef
19.
go back to reference Melzer R, Pauli C, Treumann T, Krauss B (2014) Gout tophus detection-a comparison of dual-energy CT (DECT) and histology. Semin Arthritis Rheum 43:662–665CrossRef Melzer R, Pauli C, Treumann T, Krauss B (2014) Gout tophus detection-a comparison of dual-energy CT (DECT) and histology. Semin Arthritis Rheum 43:662–665CrossRef
20.
go back to reference Dalbeth N, House ME, Aati O et al (2015) Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis 74:908–911CrossRef Dalbeth N, House ME, Aati O et al (2015) Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis 74:908–911CrossRef
21.
go back to reference Saltybaeva N, Jafari ME, Hupfer M, Kalender WA (2014) Estimates of effective dose for CT scans of the lower extremities. Radiology 273:153–159CrossRef Saltybaeva N, Jafari ME, Hupfer M, Kalender WA (2014) Estimates of effective dose for CT scans of the lower extremities. Radiology 273:153–159CrossRef
23.
go back to reference Hamburger M, Baraf HS, Adamson TC 3rd et al (2011) 2011 recommendations for the diagnosis and management of gout and hyperuricemia. Phys Sportsmed 39:98–123CrossRef Hamburger M, Baraf HS, Adamson TC 3rd et al (2011) 2011 recommendations for the diagnosis and management of gout and hyperuricemia. Phys Sportsmed 39:98–123CrossRef
24.
go back to reference Neogi T, Jansen TL, Dalbeth N et al (2015) 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 74:1789–1798CrossRef Neogi T, Jansen TL, Dalbeth N et al (2015) 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 74:1789–1798CrossRef
25.
go back to reference Schlee S, Bollheimer LC, Bertsch T, Sieber CC, Härle P (2018) Crystal arthritides - gout and calcium pyrophosphate arthritis : part 2: clinical features, diagnosis and differential diagnostics. Z Gerontol Geriatr 51:579–584CrossRef Schlee S, Bollheimer LC, Bertsch T, Sieber CC, Härle P (2018) Crystal arthritides - gout and calcium pyrophosphate arthritis : part 2: clinical features, diagnosis and differential diagnostics. Z Gerontol Geriatr 51:579–584CrossRef
26.
go back to reference Alqatari S, Visevic R, Marshall N, Ryan J, Murphy G (2018) An unexpected cause of sacroiliitis in a patient with gout and chronic psoriasis with inflammatory arthritis: a case report. BMC Musculoskelet Disord 19:126CrossRef Alqatari S, Visevic R, Marshall N, Ryan J, Murphy G (2018) An unexpected cause of sacroiliitis in a patient with gout and chronic psoriasis with inflammatory arthritis: a case report. BMC Musculoskelet Disord 19:126CrossRef
27.
go back to reference Komlosi P, Wintermark M (2017) Dual energy computed tomography applications for the evaluation of the spine. Neuroimaging Clin N Am 27:483–487CrossRef Komlosi P, Wintermark M (2017) Dual energy computed tomography applications for the evaluation of the spine. Neuroimaging Clin N Am 27:483–487CrossRef
28.
go back to reference Toprover M, Krasnokutsky S, Pillinger MH (2015) Gout in the spine: imaging, diagnosis, and outcomes. Curr Rheumatol Rep 17:70CrossRef Toprover M, Krasnokutsky S, Pillinger MH (2015) Gout in the spine: imaging, diagnosis, and outcomes. Curr Rheumatol Rep 17:70CrossRef
29.
go back to reference Jeon JY, Lee SW, Jeong YM, Baek HJ (2019) The effect of tube voltage combination on image artefact and radiation dose in dual-source dual-energy CT: comparison between conventional 80/140 kV and 80/150 kV plus tin filter for gout protocol. Eur Radiol 29:1248–1257CrossRef Jeon JY, Lee SW, Jeong YM, Baek HJ (2019) The effect of tube voltage combination on image artefact and radiation dose in dual-source dual-energy CT: comparison between conventional 80/140 kV and 80/150 kV plus tin filter for gout protocol. Eur Radiol 29:1248–1257CrossRef
30.
go back to reference Diekhoff T, Ziegeler K, Feist E et al (2015) First experience with single-source dual-energy computed tomography in six patients with acute arthralgia: a feasibility experiment using joint aspiration as a reference. Skeletal Radiol 44:1573–1577CrossRef Diekhoff T, Ziegeler K, Feist E et al (2015) First experience with single-source dual-energy computed tomography in six patients with acute arthralgia: a feasibility experiment using joint aspiration as a reference. Skeletal Radiol 44:1573–1577CrossRef
31.
go back to reference Kiefer T, Diekhoff T, Hermann S et al (2016) Single source dual-energy computed tomography in the diagnosis of gout: diagnostic reliability in comparison to digital radiography and conventional computed tomography of the feet. Eur J Radiol 85:1829–1834CrossRef Kiefer T, Diekhoff T, Hermann S et al (2016) Single source dual-energy computed tomography in the diagnosis of gout: diagnostic reliability in comparison to digital radiography and conventional computed tomography of the feet. Eur J Radiol 85:1829–1834CrossRef
33.
go back to reference Sun Y, Chen HY, Zhang ZJ et al (2015) Dual-energy computed tomography for monitoring the effect of urate-lowering therapy in gouty arthritis. Int J Rheum Dis 18:880–885CrossRef Sun Y, Chen HY, Zhang ZJ et al (2015) Dual-energy computed tomography for monitoring the effect of urate-lowering therapy in gouty arthritis. Int J Rheum Dis 18:880–885CrossRef
34.
go back to reference Modjinou DV, Krasnokutsky S, Gyftopoulos S et al (2017) Comparison of dual-energy CT, ultrasound and surface measurement for assessing tophus dissolution during rapid urate debulking. Clin Rheumatol 36:2101–2107CrossRef Modjinou DV, Krasnokutsky S, Gyftopoulos S et al (2017) Comparison of dual-energy CT, ultrasound and surface measurement for assessing tophus dissolution during rapid urate debulking. Clin Rheumatol 36:2101–2107CrossRef
35.
go back to reference Zhu J, Li A, Jia E et al (2017) Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study. Arthritis Res Ther 19:83CrossRef Zhu J, Li A, Jia E et al (2017) Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study. Arthritis Res Ther 19:83CrossRef
Metadata
Title
Development and validation of a quantitative method for estimation of the urate burden in patients with gouty arthritis using dual-energy computed tomography
Authors
Maximilian Kotlyarov
Kay Geert A. Hermann
Jürgen Mews
Bernd Hamm
Torsten Diekhoff
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06350-1

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