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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Quantification of uric acid in vasculature of patients with gout using dual-energy computed tomography
Sharon Hannah Barazani, Wei-Wei Chi, Renata Pyzik, Helena Chang, Adam Jacobi, Tom O’Donnell, Zahi A Fayad, Yousaf Ali, Venkatesh Mani
Sharon Hannah Barazani, Renata Pyzik, Zahi A Fayad, Venkatesh Mani, Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Wei-Wei Chi, Yousaf Ali, Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Helena Chang, Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Adam Jacobi, Zahi A Fayad, Venkatesh Mani, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Tom O’Donnell, Siemens Healthineers, Erlangen 91052, Germany
Author contributions: Barazani SH prepared the first draft of the manuscript which was then revised critically for content by all authors; Barazani SH, Chi WW, Pyzik R recruited subjects and acquired data; Barazani SH, Chi WW, Pyzik R, Chang H and Mani V analyzed the data; Chi WW, Chang H, Jacobi A, Fayad ZA and Mani V interpreted the data; Chi WW, Jacobi A and Ali Y were responsible for patient safety monitoring; Jacobi A, Fayad ZA, Ali Y and Mani V conceived and designed the study; Mani V will be responsible for accuracy, and integrity of the data.
Institutional review board statement: The study was reviewed and approved by the Icahn School of Medicine at Mount Sinai, Mount Sinai St, Luke’s, Mount Sinai West.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts of interest with regards to the study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Venkatesh Mani, PhD, Associate Professor, Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States. venkatesh.mani@mssm.edu
Received: March 9, 2020
Peer-review started: March 9, 2020
First decision: April 25, 2020
Revised: June 16, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 28, 2020
BACKGROUND
Gout, caused by hyperuricemia and subsequent deposition of aggregated monosodium urate crystals (MSU) in the joints or extra-articular regions, is the most common inflammatory arthritis. There is increasing evidence that gout is an independent risk factor for hypertension, cardiovascular disease progression and mortality.
AIM
To evaluate if dual energy computed tomography (DECT) could identify MSU within vessel walls of gout patients, and if MSU deposits within the vasculature differed between patients with gout and controls. This study may help elucidate why individuals with gout have increased risk for cardiovascular disease.
METHODS
31 gout patients and 18 controls underwent DECT scans of the chest and abdomen. A material decomposition algorithm was used to distinguish regions of MSU (coded green), and calcifications (coded purple) from soft tissue (uncoded). Volume of green regions was calculated using a semi-automated volume assessment program. Between-group differences were analyzed using Mann-Whitney U exact test and nonparametric rank regression.
RESULTS
Gout patients had significantly higher volume of MSU within the aorta compared to controls [Median (Min-Max) of 43.9 (0-1113.5) vs 2.9 (0-219.4), P = 0.01]. Number of deposits was higher in gout patients compared to controls [Median (Min-Max) of 20 (0-739) vs 1.5 (0-104), P = 0.008]. However, the difference was insignificant after adjustment for age, gender, history of cardiovascular disease and diabetes. Increased age was positively associated with total urate volume (rs = 0.64; 95% confidence interval: 0.43-0.78).
CONCLUSION
This pilot study showed that DECT can quantify vascular urate deposits with variation across groups, with gout patients possibly having higher deposition. This relationship disappeared when adjusted for age, and there was a positive relationship between age and MSU deposition. While this study does not prove that green coded regions are truly MSU deposition, it corroborates recent studies that show the presence of vascular deposition.
Core tip: There is increasing evidence that gout is an independent risk factor for cardiovascular disease progression. In hyperuricemic individuals, monosodium urate may be deposited within the vessel wall and possibly lead to an inflammatory cascade. We examine if dual energy computed tomography can quantify monosodium urate depositions in the vasculature of gout patients, and measure deposits volumetrically to see if they are higher in these individuals compared to healthy controls. The study shows that dual energy computed tomography can detect vascular deposits and that gout patients possibly have increased deposition, and corroborates recent studies that show the presence of vascular deposition.
