ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 0647

Dual-energy CT versus Ultrasound, Alone or in Combination, for the Diagnosis of Gout: A Diagnostic Performance Study

Jasvinder Singh1, Fabio Becce2, Jean--Francois Budzik3 and Tristan Pascart4, 1University of Alabama at Birmingham, Birmingham, AL, 2Lausanne University, Lausanne, Switzerland, 3University of Lille, Lille, France, 4Ghicl, Hôpital Saint-Philibert, department of rheumatology, Lomme, France

Meeting: ACR Convergence 2020

Keywords: gout, Ultrasound

  • Tweet
  • Email
  • Print
Session Information

Date: Saturday, November 7, 2020

Session Title: Metabolic & Crystal Arthropathies Poster

Session Type: Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: To examine the diagnostic accuracy of dual-energy computed tomography (DECT) vs. ultrasound  or their combination for the diagnosis of gout.

Methods: Using data from an outpatient rheumatology clinic, we examined the sensitivity, specificity, positive and negative predictive value (PPV, NPV) and area under the receiver operating characteristic (ROC) curve (AUC) of either modality or their combination for gout diagnosis. We used two standards: (1) demonstration of monosodium urate (MSU) crystals in synovial fluid (gold); and (2) 2015 American College of Rheumatology and European League Against Rheumatism (ACR-EULAR) classification criteria for gout, modified to exclude points based on DECT and ultrasound findings (silver), since these were test standards.

Results: Of the 147 patients who provided data, 48 had synovial fluid analysis performed (38 had MSU crystals and 10 were MSU-crystal negative). The mean age of 64.7 years (standard deviation, 14.3) and a mean symptom duration of 9.2 years. 113 (77%) met the silver standard, i.e. modified ACR-EULAR classification criteria for gout, and 34 (23%) did not.

Compared to the gold standard of synovial fluid MSU crystal positivity, the accuracy statistics for feet DECT, knee DECT, feet ultrasound double contour (DC) sign, combined feet DECT and feet ultrasound diagnosis (DC sign or tophus), and combined knee and feet DECT and ultrasound were: (1) sensitivity, 87%, 91%, 76%, 95%, 97%; (2) specificity, 100%, 87%, 60%, 60%, 50%; (3) PPV, 100%, 97%, 88%, 90%, 88%; (4) NPV, 67%, 75%, 40%, 70%, 83%; (5) AUC, 0.93, 0.89, 0.68, 0.77, and 0.74 (Table 1). These findings were replicated compared to the modified ACR-EULAR gout classification criteria, but with lower numbers (Table 2). Feet DECT, followed by knee DECT had the highest accuracy for the diagnosis of gout (Figure 2); ultrasound DC sign or the combination of DECT and ultrasound or across joints had lower accuracy.

Conclusion: In a single-center rheumatology clinic study, feet or knee DECT had the best overall accuracy statistics for the diagnosis of gout. DECT/ultrasound combination or multiple joint imaging may offer no additional increase in overall diagnostic accuracy.

Table 1. Diagnostic accuracy of DECT and ultrasound modalities for gout with MSU positivity as the gold standard (n=48)

Table 2. Diagnostic accuracy of DECT and ultrasound modalities for gout with modified ACR/EULAR gout classification criteria as the silver standard (N=147)

Figure 1. Area under the curve for the DECT and ultrasound modalities, alone or combined for feet/ankles, knees and both areas combined against the gold standard of synovial fluid monosodium urate (MSU) crystals Figure legend: The X-axis represents 1-specificity and Y-axis represents sensitivity. The null hypothesis is the diagonal line with an area of 0.50; the greater the area, the higher the overall accuracy of each modality. The area was highest for feet DECT (0.93) and lowest for feet ultrasound double contour (DC) sign (0.68).


Disclosure: J. Singh, Crealta/Horizon, 1, Medisys, 1, Fidia, 1, UBM LLC, 1, Trio health, 1, Medscape, 1, WebMD, 1, Clinical Care options, 1, Clearview healthcare partners, 1, Putnam associates, 1, Focus forward, 1, Navigant consulting, 1, Spherix, 1, Practice Point communications, 1, the National Institutes of Health, 1, the American College of Rheumatology, 1, Amarin pharmaceuticals, 1, Viking therapeutics, 1, OMERACT, 1; F. Becce, Horizon Therapeutics, 5; J. Budzik, None; T. Pascart, novartis, 8, Horizon, 2.

To cite this abstract in AMA style:

Singh J, Becce F, Budzik J, Pascart T. Dual-energy CT versus Ultrasound, Alone or in Combination, for the Diagnosis of Gout: A Diagnostic Performance Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/dual-energy-ct-versus-ultrasound-alone-or-in-combination-for-the-diagnosis-of-gout-a-diagnostic-performance-study/. Accessed January 27, 2023.
  • Tweet
  • Email
  • Print

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/dual-energy-ct-versus-ultrasound-alone-or-in-combination-for-the-diagnosis-of-gout-a-diagnostic-performance-study/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2023 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences