Background/Purpose: Dual-energy computed tomography (DECT) is a sensitive method for identifying uric acid deposits in joints and periarticular soft tissues in patients suspected of having gout. Diagnosis of gout cannot be confirmed by polarized microscopy during asymptomatic (intercritical) periods as joint aspiration is not feasible in most cases. We estimated the yield of dual-energy computed tomography (CT) in detection of uric acid tissue deposits during intercritical periods in patients suspected of having gout.

Methods: Patients aged at least 18 years with a history of recurrent, short-lived mono- or oligo-arthralgia or arthritis, referred to the rheumatology clinic for diagnosis of their condition, were included. All had uric acid levels >6 mg/dl and were completely asymptomatic at the time of clinical and radiological evaluations. Patients with a confirmed diagnosis of gout and patients on urate-lowering medicationswere excluded. DECT screened the specific joints and periarticular soft tissues that were previously involved in each case.

Results: 22 patients (18 men, 4 women) were included. Their mean age was 57+17 years. Articular or soft-tissue urate deposits were identified by DECT in 11 cases (50%). Uric acid level did not differ significantly between the groups with or without deposits (8.5+2 and 8.7+1.2 mg/dl, respectively). The table shows the yield of DECT in various anatomic locations:

Area screened	feet	knees	elbows	hands
Number of cases	18	8	1	4
Cases with urate deposits	7	2	0	3
% with urate deposits	39%	25%	0	75%

Conclusion: In asymptomatic hyperuricemic patients with a history of recurrent short-lived mono- or oligo-arthralgia or arthritis, DECT identified urate crystals in 50%, confirming a diagnosis of gout. DECT is a valuable tool in diagnosing gout during intercritical periods.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/dual-energy-computed-tomography-as-a-diagnostic-tool-for-gout-during-intercritical-periods/