Dual Energy CT scan offers high diagnostic accuracy in established gout

Dual-energy Computed Tomography (DECT) scan offers very high accuracy in detection of preexisting gout but has low diagnostic sensitivity in detecting recent gout onset, revealed a study published in the journal, Rheumatology.

Gout is a systemic disease that results from the deposition of monosodium urate crystals (MSU) in tissues. Increased serum uric acid (SUA) above a specific threshold is a requirement for the formation of uric acid crystals. The diagnosis of gout can be confirmed clinically in the majority of patients because synovial fluid aspiration (SFA) is invasive and usually unfeasible. Scientists and radiologists are putting emphasis on non-invasive techniques like Ultrasonography and Dual Energy CT Scan or DECT.

TIn present study the authors sought to assess the utility of dual-energy CT (DECT) for diagnosing gout. In order to achieve that, a systematic literature search was performed in PubMed, EMBASE and Cochrane Library. Studies evaluating the utility of DECT for diagnosing gout were included. Reference standards were the detection of monosodium urate crystals at SF assessment or a validated set of criteria. The methodological quality of studies was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 criteria. Data from person-based and joint-/localization-based evaluations were pooled separately, and subgroup analyses for disease stage/duration and reference standard were performed.

The key observations of the analysis were: 10 studies were included; in person-based evaluations, the pooled (95% CI) sensitivity and specificity were 0.81 and 0.91, respectively. In joint-based evaluations, they were 0.83 and 0.88, respectively. At short disease duration (⩽6 weeks), the pooled (95% CI) sensitivity and specificity at the joint level were 0.55 and 0.89, respectively.

To conclude the study the authors wrote: " DECT has high diagnostic accuracy in established gout, but its diagnostic sensitivity is low in subjects with recent onset gout."

Read more: Despite readily available treatment, gout remains under-treated, finds study

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https://doi.org/10.1093/rheumatology/kez180