AJR: Use dual-energy CT to diagnose gout
Dual-energy CT can reliably diagnose gout in an acute, emergency setting, based on study results in the April issue of the American Journal of Roentgenology.
According to Savvakis Nicolaou, MD, from the radiology department at Vancouver General Hospital in Vancouver, British Columbia, and colleagues, gout affects up to six million people in the U.S. It can pose diagnostic problems since many other diseases can mimic or coexist with it and treatment is often initiated based on an assumption of the diagnosis. And joint aspiration can, the authors wrote, be technically difficult and comes with the risk of complications.
Imaging techniques such as x-ray, ultrasound, CT and MRI have been used to confirm and monitor gout, but the authors reported those techniques aren't specific enough to facilitate a diagnosis. “A noninvasive means of confirming gout before the classic radiographic changes occur, as well as monitoring response to treatment, is therefore highly desirable," the authors wrote. "The advent of dual-energy CT has the potential to achieve this goal for the first time."
The study included five cases where the diagnosis of gout was made or excluded based on dual-energy CT. “In every case, conventional imaging techniques were used before applying advanced dual-energy CT technology, however we were not able to make a diagnosis based solely upon those findings,” said Nicolaou. “ To our knowledge, dual-energy CT is the only imaging method described to date that can confirm the diagnosis of topheceaous (or chronic) gout with high accuracy."
The authors wrote that dual-energy CT's ability to detect gout at the preclinical stage allows for treatment aimed at articular and bony damage to begin earlier, "making disease regression easier to achieve and avoiding associated risks, such as increased cardiovascular mortality, decreased renal function, and formation of renal calculi. This benefit is important clinically because uric acid calculi respond well to medical therapy, thereby obviating more aggressive nonmedical treatments. In characterization of soft-tissue masses, dual-energy CT can accurately detect uric acid, thus obviating tissue aspiration, an invasive procedure."
"Dual-energy CT is an exciting problem-solving tool that can reliably diagnose the presence of topheceaous gout," said Nicolaou, "therereby expediting patient treatment, potentially reducing the burden of chronic complications associated with gout.”
According to Savvakis Nicolaou, MD, from the radiology department at Vancouver General Hospital in Vancouver, British Columbia, and colleagues, gout affects up to six million people in the U.S. It can pose diagnostic problems since many other diseases can mimic or coexist with it and treatment is often initiated based on an assumption of the diagnosis. And joint aspiration can, the authors wrote, be technically difficult and comes with the risk of complications.
Imaging techniques such as x-ray, ultrasound, CT and MRI have been used to confirm and monitor gout, but the authors reported those techniques aren't specific enough to facilitate a diagnosis. “A noninvasive means of confirming gout before the classic radiographic changes occur, as well as monitoring response to treatment, is therefore highly desirable," the authors wrote. "The advent of dual-energy CT has the potential to achieve this goal for the first time."
The study included five cases where the diagnosis of gout was made or excluded based on dual-energy CT. “In every case, conventional imaging techniques were used before applying advanced dual-energy CT technology, however we were not able to make a diagnosis based solely upon those findings,” said Nicolaou. “ To our knowledge, dual-energy CT is the only imaging method described to date that can confirm the diagnosis of topheceaous (or chronic) gout with high accuracy."
The authors wrote that dual-energy CT's ability to detect gout at the preclinical stage allows for treatment aimed at articular and bony damage to begin earlier, "making disease regression easier to achieve and avoiding associated risks, such as increased cardiovascular mortality, decreased renal function, and formation of renal calculi. This benefit is important clinically because uric acid calculi respond well to medical therapy, thereby obviating more aggressive nonmedical treatments. In characterization of soft-tissue masses, dual-energy CT can accurately detect uric acid, thus obviating tissue aspiration, an invasive procedure."
"Dual-energy CT is an exciting problem-solving tool that can reliably diagnose the presence of topheceaous gout," said Nicolaou, "therereby expediting patient treatment, potentially reducing the burden of chronic complications associated with gout.”