Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: The gold standard of acute gouty arthritis diagnosis has been to verify the presence of monosodium urate (MSU) crystal in the aspirated fluid of the affected joint. Recently, dual energy computed tomography (DECT) has emerged as a non-invasive MSU detecting tool. This study was undertaken to evaluate the diagnostic accuracy of DECT in acute gouty arthritis and to determine the affecting factors.
Methods: Medical charts of patients who underwent both DECT and ultrasound (US) guided aspiration in suspicion of acute gouty arthritis from August 2013 to March 2015 were retrospectively reviewed. Positive ultrasound findings included effusion with snowstorm appearing microtophi or double contour sign or presence of tophi. For statistical analysis, Mann-Whitney U test was used for continuous variables. Chi-Square test was used for categorical variables.
A total of 74 patients were analyzed. All patients except one were male and mean age was 45.3 years. Mean disease duration was 46 months, mean serum uric acid level 7.4 mg/dL. Fifty six patients had one or more positive findings of DECT or US or MSU presence in aspirated joint fluid. MSU deposition was observed in 28/61 (46.0%) patients. There were 4 patients who had clinically apparent tophi on physical examination, all of which were detected on DECT. Joint fluid was successfully acquired in 40/61 (65.5%) patients and the presence of MSU crystal was confirmed in 28 patients. Positive US findings were observed in 60/61 (98.4%) patients. 26 patients showed positive findings of both DECT and ultrasound, whereas 34 patients had only positive ultrasound findings. Serum uric acid level, symptom duration was significantly greater in DECT(+) positive group. Of note, DECT could not detect MSU crystal in patientswith high BMI. After adjusting age, multivariate logistic regression revealed that DECT may not be appropriate in patients with high BMI and short symptom duration in acute setting.
Conclusion: DECT can detect MSU deposition in acute gout patients without clinical tophi. However, the probability of false negativity rises in patients with high BMI and short symptom duration.
To cite this abstract in AMA style:Lee J, Lee JY, Koh JH, Chung MK, Kim JH, Kwok SK, Ju JH, Park SH. The Role of Dual Energy Computed Tomography in Diagnosing Acute Gouty Arthritis: Comparison with Ultrasound and Aspiration [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-role-of-dual-energy-computed-tomography-in-diagnosing-acute-gouty-arthritis-comparison-with-ultrasound-and-aspiration/. Accessed February 18, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-role-of-dual-energy-computed-tomography-in-diagnosing-acute-gouty-arthritis-comparison-with-ultrasound-and-aspiration/