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Li M, Zhang H, Liu JN, Zhong F, Zheng SY, Zhang J, Chen SX, Lin RF, Zhang KY, Liu XM, Xu YK, Li J. Performance of novel multiparametric second-generation dual-layer spectral detector CT in gouty arthritis. Eur Radiol 2025; 35:2448-2456. [PMID: 39562365 DOI: 10.1007/s00330-024-11205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 09/05/2024] [Accepted: 10/11/2024] [Indexed: 11/21/2024]
Abstract
OBJECTIVES This study aimed to compare the performance of different dual-energy computed tomography (DECT) technologies in detecting monosodium urate (MSU) crystals and evaluate the potential clinical value of novel second-generation dual-layer spectral detector CT (dlDECT) in gouty arthritis. METHODS Using data collected from a tertiary hospital, we examined the diagnostic accuracy of different DECT technologies for the diagnosis of MSU. We used two standards: (1) demonstration of MSU crystals in synovial fluid (gold) and (2) 2015 ACR/EULAR gout classification criteria (silver). Furthermore, six novel spectral parameters derived from dlDECT were quantitatively calculated and analyzed for MSU diagnostic efficiency. RESULTS Of the 243 patients with 387 joints, 68 (27.98%) had synovial fluid analysis. Compared with the gold standard, MSU diagnostic accuracy statistics for dlDECT, dual-source DECT (dsDECT) and rapid kilovolt peak switching DECT (rsDECT) were as follows: area under the curve (AUC): 0.85, 0.80 and 0.75, respectively. Findings were replicated compared with the silver standard. Multiparametric analysis in dlDECT demonstrated the highest MSU detection rate (92.86%), significantly higher than rsDECT (42.08%) and dsDECT (85.80%). Among novel parameters in dlDECT, Calcium-suppressed index 25 (CaSupp-I 25) exhibited the best performance in distinguishing materials (MSU, muscle, and bone), with an AUC of 0.992. The differentiation was also aided by histograms, scatter plots, and attenuation curves. CONCLUSION The novel dlDECT is likely not inferior to other DECT technologies in MSU detection, especially its spectral parameter CaSupp-I 25. Multiparameter analysis showed the potential value for detecting MSU crystals in gouty arthritis, providing valuable clinical insights for gout diagnosis. KEY POINTS Question The performance of different DECT technologies in detecting monosodium urate (MSU), and the value of dual-layer spectral detector CT (dlDECT) in gouty arthritis remains unclear. Findings The dlDECT was likely not inferior to other DECT technologies in MSU detection, and its multiparametric analysis provided valuable information for MSU diagnosis. Clinical relevance Novel dlDECT may improve the accurate detection of MSU crystals in gouty arthritis compared to other DECT technologies, providing valuable clinical insights and potentially improving patient outcomes for more precise gout diagnosis.
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Affiliation(s)
- Meng Li
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Zhang
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Traditional Chinese Internal Medicine, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Jia-Ni Liu
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Traditional Chinese Internal Medicine, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Fei Zhong
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Song-Yuan Zheng
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Zhang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shi-Xian Chen
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rui-Feng Lin
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Traditional Chinese Internal Medicine, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Kang-Yu Zhang
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao-Min Liu
- Philips (China) Investment Co. Ltd., Guangzhou, China
| | - Yi-Kai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Juan Li
- Department of Rheumatology and Immunology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- Department of Traditional Chinese Internal Medicine, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China.
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Sirotti S, Pascart T, Thiele R, Filippou G. Imaging of crystal-induced arthropathies in 2025. Best Pract Res Clin Rheumatol 2025:102063. [PMID: 40204529 DOI: 10.1016/j.berh.2025.102063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2025] [Revised: 03/24/2025] [Accepted: 03/31/2025] [Indexed: 04/11/2025]
Abstract
In recent years, imaging has become an essential tool in the assessment of crystal-induced arthropathies (CIAs), including gout, calcium pyrophosphate deposition disease, and basic calcium phosphate crystal deposition. Advances in imaging have improved diagnosis and disease monitoring, leading to its integration into classification criteria and clinical guidelines. Ultrasound (US), conventional radiography (CR), and dual-energy computed tomography (DECT) each offer unique advantages. US is a widely accessible, cost-effective, and dynamic tool, while DECT provides crystal-specific images, aiding particularly in gout diagnosis. CR, though less sensitive to early crystal deposition, remains valuable for evaluating structural damage and chronic changes. Despite these advances, challenges remain. The specificity and sensitivity of imaging findings need further validation, and the clinical relevance of certain imaging features is debated. This review summarizes recent developments, highlights key strengths, and discusses unresolved issues, emphasizing areas where future research is needed to optimize imaging use in CIAs.
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Affiliation(s)
- Silvia Sirotti
- Rheumatology Department, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.
| | - Tristan Pascart
- Rheumatology Department, Lille Catholic University, Saint Philibert Hospital, EA 7446 - ETHICS, Lille, France.
| | - Ralf Thiele
- Department of Medicine, Allergy/Immunology & Rheumatology Division, University of Rochester School of Medicine and Dentistry, Rochester, USA.
| | - Georgios Filippou
- Rheumatology Department, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.
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Yan M, Du M, Yu T, Xiao L, Li Y, Wang C, Li X, Ning C. Concordance of Ultrasound and Dual-Energy CT in Diagnosing Gouty Arthritis in the Knee Joint: A Retrospective Observational Study. Acad Radiol 2025; 32:316-325. [PMID: 39245598 DOI: 10.1016/j.acra.2024.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024]
Abstract
RATIONALE AND OBJECTIVES To assess the consistency between ultrasound and dual-energy computed tomography (DECT) for the diagnosis of gout in the knee joint. MATERIALS AND METHODS The ultrasound and DECT images of 176 knee joints from 167 patients diagnosed with gout at the Gout Specialty Clinic of Qingdao University Affiliated Hospital from February 2022 to December 2023 were retrospectively analyzed. The knee joint was segmented into five anatomical regions: intra-articular, anterior, posterior, medial, and lateral. The location of monosodium urate (MSU) crystal deposition was recorded. Tophi were classified as hypoechogenic, isoechogenic, hyperechogenic, or strongly echogenic. The Kappa test was used to assess the consistency between the two examination methods in different regions of the knee joint. The McNemar chi-square test was utilized to conduct a differential analysis between the DECT and ultrasound results. The chi-square test was used to assess differences in the rate of tophi detection with different echogenicities by DECT. Pearson's correlation coefficient was used to assess the correlation between MSU crystal deposition volume and clinically relevant indicators. RESULTS Double contour (61.4%) was the most common intra-articular ultrasound sign. In the extra-articular region, MSU crystals were commonly deposited in and around the popliteal groove region (ultrasound: 52.3%; DECT: 60.0%). Corresponding MSU deposits on DECT were found in 7 of 54 joints with aggregates detected on ultrasound, and in 15 of 108 joints with DC. Tophi with hyperechogenicity or strong echogenicity were more likely to be detected on DECT than those with hypoechoic or isoechoic features (84.3% and 90.9% vs. 55.1% and 27.8%, respectively). For the assessment of MSU deposits, ultrasound showed an overall higher positive rate than DECT (81.1% vs. 72.2%), with poor consistency between the two examinations (κ = 0.177). In distinct anatomical regions, ultrasound and DECT showed high consistency in the medial (κ = 0.651) and lateral (κ = 0.705) views, with no significant difference. The intra-articular (κ = 0.316) and anterior (κ = 0.346) regions exhibited only fair consistency, with statistically significant diagnostic differences. When exclusively assessing cases with tophi, ultrasound and DECT demonstrated similar consistency in the medial, lateral and anterior views (κ = 0.633, 0.712, and 0.400, respectively), with statistically significant differences. In the intra-articular region, the consistency was reduced (κ = 0.237), and the differences were statistically significant. CONCLUSION Ultrasound and DECT are effective methods to detect MSU deposition in gout of the knee. However, the consistency between the two techniques varies in different anatomical locations. Clinical assessment should be tailored based on the specific anatomical position. DECT is advantageous for the evaluation of intra-articular MSU deposits, while ultrasound is more sensitive for the early detection of scattered MSU deposits.
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Affiliation(s)
- Mengmeng Yan
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.)
| | - Meixia Du
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.)
| | - Tong Yu
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (T.Y., X.L.)
| | - Lishan Xiao
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.)
| | - Yuchen Li
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.)
| | - Can Wang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (C.N.)
| | - Xiaoli Li
- Department of Radiology, the Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (T.Y., X.L.)
| | - Chunping Ning
- Department of Abdominal Ultrasound, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan District, Qingdao City, Shandong Province, China (M.Y., M.D., L.X., Y.L., C.N.).
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Fukuda T, Subramanian M, Noda K, Kumeta S, Mori H, Ikeda N, Ojiri H. The comprehensive role of dual-energy CT in gout as an advanced diagnostic innovation. Skeletal Radiol 2024:10.1007/s00256-024-04856-4. [PMID: 39690304 DOI: 10.1007/s00256-024-04856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 11/17/2024] [Accepted: 12/08/2024] [Indexed: 12/19/2024]
Abstract
Gout is a common and growing health concern globally, marked by the deposition of monosodium urate (MSU) crystals in joints and soft tissues. While diagnosis relies on synovial fluid analysis, it is limited by technical difficulties and a notable rate of false negatives. Over the past decade, dual-energy computed tomography (DECT) has emerged as a highly sensitive and less-invasive modality for detecting MSU crystals. DECT offers several advantages, including the ability to visualize both intra- and extra-articular MSU deposits and to monitor crystal burden over time. It also aids in treatment planning by accurately assessing the therapeutic response. However, sensitivity of DECT can be lower in early-stage gout, and artifacts can occasionally result in false positives. Recent studies have highlighted new values of using DECT, such as predicting future flares in gout patients. In this review, we focus on the comprehensive clinical utility of DECT and its potential pitfalls in the diagnosis and management of gout.
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Affiliation(s)
- Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan.
| | - Manickam Subramanian
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90, Yishun Central, Singapore
| | - Kentaro Noda
- Division of Rheumatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Shohei Kumeta
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Haruki Mori
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Naoki Ikeda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
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Held J, Strolz C, Reijnierse M, Taljanovic M, Lacaita PG, Ouaret M, Gizewski ER, Weiss G, Klauser AS. Diagnostic Impact of Subcutaneous Edema in Gouty Feet Detected by Dual-Energy Computed Tomography and Ultrasound. J Clin Med 2024; 13:7620. [PMID: 39768543 PMCID: PMC11676054 DOI: 10.3390/jcm13247620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/02/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025] Open
Abstract
Background: The objective of our study was to evaluate the association and frequency of subcutaneous lymphedema in patients with gout primarily affecting the feet. Methods: In 79 patients with acute gout, ultrasound (US) and dual-energy computed tomography (DECT) were performed to assess the presence of subcutaneous edema and extra- and intra-articular gouty deposits. In addition, the diagnostic utility of two post-processing DECT protocols were evaluated, comprising different minimum attenuation thresholds of 150 HU (DECT 150 protocol) and 120 HU (DECT 120 protocol), with the same maximum attenuation threshold (500 HU) and constant kilovoltage setting of tubes A and B at 80 and 140 kVp. Results: Subcutaneous lymphedema was present in 58.2% of patients, with a significant association with extra-articular monosodium urate (MSU) deposits (p < 0.001). Specifically, 97.8% of patients with lymphedema had extra-articular MSU deposits in DECT or US examination, while no cases of lymphedema were found in patients with exclusively intra-articular deposits. The DECT 120 protocol was significantly more sensitive for detecting peripheral MSU deposits (81%) compared to the DECT 150 protocol (34.2%, p < 0.001). Conclusions: Our findings demonstrate that the presence of lymphedema in patients with gout is frequently associated with extra-articular manifestations of the disease.
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Affiliation(s)
- Julia Held
- Department of Internal Medicine II, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (J.H.); (G.W.)
| | - Christoph Strolz
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (C.S.); (M.O.); (E.R.G.); (A.S.K.)
| | - Monique Reijnierse
- Division of Musculoskeletal Radiology, Department of Radiology, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands;
| | - Mihra Taljanovic
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85724, USA;
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Pietro G. Lacaita
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (C.S.); (M.O.); (E.R.G.); (A.S.K.)
| | - Miar Ouaret
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (C.S.); (M.O.); (E.R.G.); (A.S.K.)
| | - Elke R. Gizewski
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (C.S.); (M.O.); (E.R.G.); (A.S.K.)
| | - Günter Weiss
- Department of Internal Medicine II, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (J.H.); (G.W.)
| | - Andrea S. Klauser
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (C.S.); (M.O.); (E.R.G.); (A.S.K.)
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Thiele RG. New Developments in Imaging in Crystalline Arthritis. Rheum Dis Clin North Am 2024; 50:683-700. [PMID: 39415374 DOI: 10.1016/j.rdc.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2024]
Abstract
Crystalline arthropathies are among the most frequently encountered conditions in medicine. Joint aspiration and microscopy used to be the diagnostic gold standard, but recent recommendations mention that this may not be necessary if typical findings are seen on imaging. Ultrasound, dual-energy computed tomographic (CT) scan, and conventional radiography are recommended in the assessment of gout, calcium pyrophosphate crystal deposition disease, and basic calcium phosphate-related disease. Ultrasound can identify the tophus and its associated tissues that participate in the inflammatory response, and dual-energy CT can find tophaceous material in regions that are difficult to access by physical examination or ultrasound.
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Affiliation(s)
- Ralf G Thiele
- Department of Medicine, Allergy/Immunology & Rheumatology Division, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 695, Rochester, NY 14642, USA.
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Zhang Y, Liu Y, Zhao Y, Zhang Y, Xia C, Ye Z, Li H, Romman Z, Yao H, Li Z, Tang J. Application of improved urate analysis algorithm based on spectral parameters in Podagra: A prospective study. Eur J Radiol 2024; 181:111769. [PMID: 39357289 DOI: 10.1016/j.ejrad.2024.111769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/06/2024] [Accepted: 09/27/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVES To explore whether the improved urate analysis (IUA) algorithm based on spectral parameters can reduce false positives in CT gout images compared with current urate analysis (CUA) algorithm. MATERIALS AND METHODS This prospective study was performed from May 2022 to May 2023. Spectral feet CT images of suspected gout participants were reconstructed by IUA and CUA algorithm. Qualitative diagnosis of IUA and CUA images was recorded and compared with the reference standard (ultrasound + conventional CT). Artifacts on IUA and CUA images of non-gout participants were recorded and compared; the maximum cross-sectional area of the maximum tophi (SIT-max) on IUA and CUA images of participants with gout were measured and compared. RESULTS There are 65 participants (mean age, 43.9 years ± 13.1 [SD]; 65 men) with 114 feet studies in the gout group, and 33 participants (mean age, 43.4 years ± 15.0 [SD]; 30 men) with 65 feet studies in the non-gout group. For all 179 feet studies, IUA images had higher specificity (19.2-86.6 % vs. 1.3-44.3 %) and accuracy (63.1-88.8 % vs. 41.3-57.0 %) than CUA images (P < 0.001). In the non-gout group, the reduction rates of artifacts from the nail bed, skin, beam hardening, vascular structures, tendons, and total artifacts on the IUA images compared to the CUA images was 40.5 %, 48.9 %, 74.3 %, 99.2 %, 99.6 %, and 80.0 %, respectively (P < 0.001). For 82 feet studies with tophi, SIT-max was higher on CUA images than IUA images (P < 0.05). CONCLUSION The improved urate analysis algorithm based on spectral parameters can reduce image artifacts and improve diagnostic efficacy.
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Affiliation(s)
- Yiteng Zhang
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
| | - Yi Liu
- Department of Rheumatism and Immunology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
| | - Yi Zhao
- Department of Rheumatism and Immunology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
| | - Yu Zhang
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
| | - Zheng Ye
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
| | - Hanyu Li
- Department of Purchasing and Supply, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
| | | | - Hui Yao
- Philips Healthcare Suzhou Co Ltd., Suzhou, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China.
| | - Jing Tang
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China.
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Held J, Haschka D, Lacaita PG, Feuchtner GM, Klotz W, Stofferin H, Duftner C, Weiss G, Klauser AS. Review: The Role of Dual-Energy Computed Tomography in Detecting Monosodium Urate Deposits in Vascular Tissues. Curr Rheumatol Rep 2024; 26:302-310. [PMID: 38739298 PMCID: PMC11224090 DOI: 10.1007/s11926-024-01151-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE OF REVIEW To highlight novel findings in the detection of monosodium urate deposits in vessels using dual energy computed tomography, and to discuss the potential clinical implications for gout and hyperuricemia patients. RECENT FINDINGS Gout is an independent risk factor for cardiovascular disease. However, classical risk calculators do not take into account these hazards, and parameters to identify patients at risk are lacking. Monosodium urate measured by dual energy computed tomography is a well-established technology for the detection and quantification of monosodium urate deposits in peripheral joints and tendons. Recent findings also suggest its applicability to identify vascular urate deposits. Dual energy computed tomography is a promising tool for detection of cardiovascular monosodium urate deposits in gout patients, to better delineate individuals at increased risk for cardiovascular disease.
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Affiliation(s)
- Julia Held
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - David Haschka
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria.
| | - Pietro G Lacaita
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gudrun M Feuchtner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Klotz
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Stofferin
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University Innsbruck, Innsbruck, Austria
| | - Christina Duftner
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Yeoh SC, Wu WT, Shih JT, Su WC, Yeh KT. Subsequent bilateral acute carpal tunnel syndrome due to tophaceous infiltration: A case report. World J Clin Cases 2024; 12:418-424. [PMID: 38313652 PMCID: PMC10835701 DOI: 10.12998/wjcc.v12.i2.418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Acute carpal tunnel syndrome (ACTS) is commonly caused by repetitive strain, trauma, or inflammatory conditions. However, ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported. This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications. CASE SUMMARY A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout. Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo, the patient underwent emergency decompression surgery for both wrists at different time points. Postoperatively, he exhibited complete recovery of sensory and motor functions, with no recurrence at long-term follow-up. Favorable outcomes were achieved through immediate decompression surgery, anti-inflammatory medications, postoperative active and passive range-of-motion exercises, and intermittent wrist splinting. Prompt diagnosis and surgical intervention, when necessary, are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS. An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes. CONCLUSION Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.
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Affiliation(s)
- Soon-Chin Yeoh
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Wen-Tien Wu
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Jui-Tien Shih
- Department of Orthopaedic Surgery, Taoyuan Armed Forces General Hospital, Taoyuan 325208, Taiwan
| | - Wen-Chin Su
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- Department of Clinical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
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Klauser AS, Strobl S, Schwabl C, Kremser C, Klotz W, Vasilevska Nikodinovska V, Stofferin H, Scharll Y, Halpern E. Impact of Dual-Energy Computed Tomography (DECT) Postprocessing Protocols on Detection of Monosodium Urate (MSU) Deposits in Foot Tendons of Cadavers. Diagnostics (Basel) 2023; 13:2208. [PMID: 37443602 DOI: 10.3390/diagnostics13132208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To evaluate two different dual-energy computed tomography (DECT) post-processing protocols for the detection of MSU deposits in foot tendons of cadavers with verification by polarizing light microscopy as the gold standard. MATERIAL AND METHODS A total of 40 embalmed cadavers (15 male; 25 female; median age, 82 years; mean, 80 years; range, 52-99; SD ± 10.9) underwent DECT to assess MSU deposits in foot tendons. Two postprocessing DECT protocols with different Hounsfield unit (HU) thresholds, 150/500 (=established) versus 120/500 (=modified). HU were applied to dual source acquisition with 80 kV for tube A and 140 kV for tube B. Six fresh cadavers (4 male; 2 female; median age, 78; mean, 78.5; range 61-95) were examined by DECT. Tendon dissection of 2/6 fresh cadavers with positive DECT 120 and negative DECT 150 studies were used to verify MSU deposits by polarizing light microscopy. RESULTS The tibialis anterior tendon was found positive in 57.5%/100% (DECT 150/120), the peroneus tendon in 35%/100%, the achilles tendon in 25%/90%, the flexor halluces longus tendon in 10%/100%, and the tibialis posterior tendon in 12.5%/97.5%. DECT 120 resulted in increased tendon MSU deposit detection, when DECT 150 was negative, with an overall agreement between DECT 150 and DECT 120 of 80% (p = 0.013). Polarizing light microscope confirmed MSU deposits detected only by DECT 120 in the tibialis anterior, the achilles, the flexor halluces longus, and the peroneal tendons. CONCLUSION The DECT 120 protocol showed a higher sensitivity when compared to DECT 150.
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Affiliation(s)
| | - Sylvia Strobl
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Schwabl
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christian Kremser
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Werner Klotz
- Department of Internal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Violeta Vasilevska Nikodinovska
- University Surgical Clinic "St. Naum Ohridski", Faculty of Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Hannes Stofferin
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Yannick Scharll
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ethan Halpern
- Jefferson Prostate Diagnostic and Kimmel Cancer Center, Department of Radiology and Urology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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11
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Subhas N, Wu F, Fox MG, Nacey N, Aslam F, Blankenbaker DG, Caracciolo JT, DeJoseph DA, Frick MA, Jawetz ST, Said N, Sandstrom CK, Sharma A, Stensby JD, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis, Crystalline Arthritis, or Erosive Osteoarthritis: 2022 Update. J Am Coll Radiol 2023; 20:S20-S32. [PMID: 37236743 DOI: 10.1016/j.jacr.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity because there is significant overlap of imaging findings among the various types of arthritis. This document provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Fangbai Wu
- Research Author, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Michael G Fox
- Program Director and Panel Chair, Mayo Clinic Arizona, Phoenix, Arizona
| | - Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia
| | - Fawad Aslam
- Mayo Clinic, Scottsdale, Arizona, Rheumatologist
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jamie T Caracciolo
- Section Head, Musculoskeletal Imaging, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; and Chair, MSK-RADS (Bone) Committee
| | | | - Matthew A Frick
- Chair of Education, Department of Radiology, Chair of Musculoskeletal Imaging, Mayo Clinic, Rochester, Minnesota
| | | | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Claire K Sandstrom
- University of Washington Medical Center, Seattle, Washington; Committee on Emergency Radiology-GSER
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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12
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Choi H, Ryu J, Lee S, Kim YJ, Bang S. [Detection of Monosodium Urate Crystal of Hand and Wrist in Suspected Gouty Arthritis Patients on Dual-Energy CT and Relationship with Serum Urate Level]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:212-225. [PMID: 36818719 PMCID: PMC9935968 DOI: 10.3348/jksr.2021.0003n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 02/10/2023]
Abstract
Purpose We retrospectively investigated the characteristics of patients with monosodium urate (MSU) deposits of the hand and wrist on dual-energy CT (DECT) compared to those without. We also attempted to determine the pattern of MSU distribution in DECT. Materials and Methods In total, 93 patients were included who had undergone DECT for evaluation of the hand or wrist pain under the clinical impression of gouty arthritis. The total volume of MSU deposits on DECT was calculated and the pattern of MSU distribution on DECT was analyzed. Also, the level of the serum urate at the time of DECT and the highest level of the serum urate of the patients were obtained from their records and the relationship between MSU and serum urate level was evaluated. Results The range of the volume of MSU deposits on DECT was 0.01-16.11 cm3 (average: 1.07 cm3). The average level of serum urate was significantly higher in the MSU positive group than that in the MSU negative group. MSU deposits were most frequently observed in the wrists followed by fingers and digitorum tendons. Conclusion On DECT, MSU deposits were most frequently detected in the wrist and related with high serum urate level.
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Affiliation(s)
- Hana Choi
- Department of Radiology, Hanyang University School of Medicine, Guri Hospital, Guri, Korea
| | - Jeongah Ryu
- Department of Radiology, Hanyang University School of Medicine, Guri Hospital, Guri, Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Yeo Ju Kim
- Department of Radiology, Hanyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Soyoung Bang
- Department of Rheumatology, Hanyang University School of Medicine, Guri Hospital, Guri, Korea
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13
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Virtual Monochromatic Images from Dual-Energy Computed Tomography Do Not Improve the Detection of Synovitis in Hand Arthritis. Diagnostics (Basel) 2022; 12:diagnostics12081891. [PMID: 36010241 PMCID: PMC9406820 DOI: 10.3390/diagnostics12081891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to investigate subtraction images from different polychromatic and virtual monochromatic reconstructions of dual-energy computed tomography (CT) for the detection of inflammation (synovitis/tenosynovitis or peritendonitis) in patients with hand arthritis. In this IRB-approved prospective study, 35 patients with acute hand arthritis underwent contrast-enhanced dual-energy CT and musculoskeletal ultrasound (MSUS) of the clinically dominant hand. CT subtractions (CT-S) were calculated from 80 and 135 kVp source data and monochromatic 50 and 70 keV images. CT-S and MSUS were scored for synovitis and tenosynovitis/peritendonitis. Specificity, sensitivity and diagnostic accuracy were assessed by using MSUS as a reference. Parameters of objective image quality were measured. Thirty-three patients were analyzed. MSUS was positive for synovitis and/or tenosynovitis/peritendonitis in 28 patients. The 70 keV images had the highest diagnostic accuracy, with 88% (vs. 50 keV, 82%; 80 kVp, 85%; and 135 kVp, 82%), and superior sensitivity, with 96% (vs. 50 keV: 86%, 80 kVp: 93% and 135 kVp: 79%). The 80 kVp images showed the highest signal- and contrast-to-noise ratio, while the 50 keV images provided the lowest image quality. While all subtraction methods of contrast-enhanced dual-energy CT proved to be able to detect inflammation with sufficient diagnostic accuracy, virtual monochromatic images with low keV showed no significant improvement over conventional subtraction techniques and lead to a loss of image quality.
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14
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Imaging of Crystal Disorders:: Calcium Pyrophosphate Dihydrate Crystal Deposition Disease, Calcium Hydroxyapatite Crystal Deposition Disease and Gout Pathophysiology, Imaging, and Diagnosis. Radiol Clin North Am 2022; 60:641-656. [PMID: 35672096 DOI: 10.1016/j.rcl.2022.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Crystal arthropathies are a group of joint disorders due to deposition of crystals in and around joints that lead to joint destruction and soft tissue masses. Clinical presentation is variable and diagnosis might be challenging. In this article the pathophysiology is addressed, the preferred deposition of crystal arthropathies and imaging findings. Case studies of calcium pyrophosphate dihydrate crystal deposition disease, hydroxyapatite crystal deposition disease, and gout are shown. Guidelines for the use of dual-energy computed tomography are given to enable the diagnosis and follow-up of gout.
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15
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Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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16
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Klauser AS, Strobl S, Schwabl C, Klotz W, Feuchtner G, Moriggl B, Held J, Taljanovic M, Weaver JS, Reijnierse M, Gizewski ER, Stofferin H. Prevalence of Monosodium Urate (MSU) Deposits in Cadavers Detected by Dual-Energy Computed Tomography (DECT). Diagnostics (Basel) 2022; 12:diagnostics12051240. [PMID: 35626395 PMCID: PMC9139977 DOI: 10.3390/diagnostics12051240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Dual-energy computed tomography (DECT) allows direct visualization of monosodium urate (MSU) deposits in joints and soft tissues. Purpose: To describe the distribution of MSU deposits in cadavers using DECT in the head, body trunk, and feet. Materials and Methods: A total of 49 cadavers (41 embalmed and 8 fresh cadavers; 20 male, 29 female; mean age, 79.5 years; SD ± 11.3; range 52–95) of unknown clinical history underwent DECT to assess MSU deposits in the head, body trunk, and feet. Lens, thoracic aorta, and foot tendon dissections of fresh cadavers were used to verify MSU deposits by polarizing light microscopy. Results: 33/41 embalmed cadavers (80.5%) showed MSU deposits within the thoracic aorta. 11/41 cadavers (26.8%) showed MSU deposits within the metatarsophalangeal (MTP) joints and 46.3% of cadavers demonstrated MSU deposits within foot tendons, larger than and equal to 5 mm. No MSU deposits were detected in the cranium/intracerebral vessels, or the coronary arteries. Microscopy used as a gold standard could verify the presence of MSU deposits within the lens, thoracic aorta, or foot tendons in eight fresh cadavers. Conclusions: Microscopy confirmed the presence of MSU deposits in fresh cadavers within the lens, thoracic aorta, and foot tendons, whereas no MSU deposits could be detected in cranium/intracerebral vessels or coronary arteries. DECT may offer great potential as a screening tool to detect MSU deposits and measure the total uric acid burden in the body. The clinical impact of this cadaver study in terms of assessment of MSU burden should be further proven.
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Affiliation(s)
- Andrea S. Klauser
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
| | - Sylvia Strobl
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
| | - Christoph Schwabl
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
- Correspondence:
| | - Werner Klotz
- Department of Internal Medicine II, Medical University Innsbruck, 6020 Innsbruck, Austria; (W.K.); (J.H.)
| | - Gudrun Feuchtner
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
| | - Bernhard Moriggl
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University Innsbruck, 6020 Innsbruck, Austria; (B.M.); (H.S.)
| | - Julia Held
- Department of Internal Medicine II, Medical University Innsbruck, 6020 Innsbruck, Austria; (W.K.); (J.H.)
| | - Mihra Taljanovic
- Department of Medical Imaging, Banner University Medical Center, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA;
| | - Jennifer S. Weaver
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Monique Reijnierse
- Division of Musculoskeletal Radiology, Department of Radiology, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands;
| | - Elke R. Gizewski
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.S.K.); (G.F.); (E.R.G.)
| | - Hannes Stofferin
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University Innsbruck, 6020 Innsbruck, Austria; (B.M.); (H.S.)
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17
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Dunham K, Tsoeriero P, Wollstein R. The Use of Ultrasound to Differentiate Between Gout and Infection in the Wrist. Curr Rheumatol Rev 2022; 18:168-171. [DOI: 10.2174/1573397118666220225150046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/11/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Abstract
Background:
Gout is a common condition and its prevalence is increasing. In the wrist, acute gouty arthritis is difficult to distinguish from infection and may occur concomitantly. Though aspiration is helpful, it is not always technically feasible or definitive. Imaging may assist in the differential diagnosis.
Case Presentation:
Two cases are described in which the use of ultrasound evaluation assisted in the diagnosis and ultimate treatment.
Conclusion:
Ultrasound can be a helpful adjunct in the diagnosis of arthritis of the wrist, helping to tailor treatment in complex cases.
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Affiliation(s)
- Kevin Dunham
- Department of Radiology New York University School of Medicine, New York, NY, USA
| | - Paul Tsoeriero
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Ronit Wollstein
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
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18
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Shang J, Zhou LP, Wang H, Liu B. Diagnostic Performance of Dual-energy CT Versus Ultrasonography in Gout: A Meta-analysis. Acad Radiol 2022; 29:56-68. [PMID: 32980243 DOI: 10.1016/j.acra.2020.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Dual-energy computed tomography (DECT), along with ultrasound (US), has been increasingly utilized for the diagnosis of gout because of its noninvasive advantages. However, the superiority of DECT over US remains controversial. This meta-analysis was performed to investigate whether DECT is superior to US in the diagnosis of gout. METHODS A comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases was conducted for potentially eligible articles. Studies that evaluated the utility of DECT or US for gout diagnosis were qualified. Two distinctive ultrasonographic features of gout, namely, the double contour sign and the presence of tophus, were also assessed. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Besides, the subgroup analyses of early disease duration (≤ 2 years) was also performed. RESULTS Twenty-eight studies were included in the meta-analysis. The pooled sensitivity and specificity of DECT were 0.89 (0.80-0.94) and 0.91 (0.88-0.94), respectively. The pooled sensitivity and specificity of US were 0.70 (0.58-0.79) and 0.95 (0.87-0.98), respectively, for double contour sign; 0.57 (0.38-0.74) and 0.99 (0.88-1.00), respectively, for tophus; and 0.84 (0.73-0.91) and 0.84 (0.78-0.89), respectively, for overall consideration of US signs. At the early disease duration (≤ 2 years), the pooled sensitivity and specificity were 0.75 (0.60-0.86) and 0.85 (0.75-0.91), respectively, for DECT; 0.93 (0.72-0.99) and 0.80 (0.71-0.86), respectively, for overall consideration of US signs. CONCLUSION DECT and US showed promising accuracy for gout diagnosis. DECT has higher sensitivity, specificity, and AUC than overall consideration of US signs and thus has a better diagnostic ability in diagnosing gout. Moreover, the diagnostic sensitivity of DECT is lower than that of overall consideration of US signs at less than 2 years' disease duration.
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19
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Weaver JS, Vina ER, Munk PL, Klauser AS, Elifritz JM, Taljanovic MS. Gouty Arthropathy: Review of Clinical Manifestations and Treatment, with Emphasis on Imaging. J Clin Med 2021; 11:jcm11010166. [PMID: 35011907 PMCID: PMC8745871 DOI: 10.3390/jcm11010166] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 12/22/2022] Open
Abstract
Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up of gouty arthropathy. The imaging findings of gouty arthropathy on radiography, ultrasonography, computed tomography, dual energy computed tomography, and magnetic resonance imaging are described to include findings of the early, acute and chronic phases of gout. These findings include early monosodium urate deposits, osseous erosions, and tophi, which may involve periarticular tissues, tendons, and bursae. Treatment of gout includes non-steroidal anti-inflammatories, colchicine, glucocorticoids, interleukin-1 inhibitors, xanthine oxidase inhibitors, uricosuric drugs, and recombinant uricase. Imaging is critical in monitoring response to therapy; clinical management can be modulated based on imaging findings. This review article describes the current standard of care in imaging and treatment of gouty arthropathy.
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Affiliation(s)
- Jennifer S. Weaver
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA;
- Correspondence:
| | - Ernest R. Vina
- Department of Medicine, University of Arizona Arthritis Center, Tucson, AZ 85724, USA;
| | - Peter L. Munk
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Department of Radiology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Andrea S. Klauser
- Radiology Department, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria;
| | - Jamie M. Elifritz
- Departments of Radiology and Pathology, University of New Mexico, Albuquerque, NM 87131, USA;
- New Mexico Office of the Medical Investigator, Albuquerque, NM 87131, USA
| | - Mihra S. Taljanovic
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA;
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85721, USA
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20
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Liu X, Zhang X, Mo S, Liang D, Li B, Zhu J. Factors Associated with Bone Erosion in Patients with Gout: A Dual-Energy Gemstone Spectral Imaging Computed Tomography Study. Mod Rheumatol 2021; 32:1170-1174. [PMID: 34918119 DOI: 10.1093/mr/roab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/27/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to assess the factors influencing bone erosion in patients with gout using dual-energy gemstone spectral imaging CT. METHODS We compared the clinical data, laboratory indices, and tissue urate levels at the monosodium urate (MSU)-bone interface measured by dual-energy gemstone spectral imaging computed tomography of 87 gout patients with (n=41) and without (n=46) bone erosion. Logistic regression analysis was used to investigate the risk factors associated with bone erosion. RESULTS In total, 47.1% of patients with gout had bone erosion. The disease duration, serum uric acid, tissue urate levels, and the presence of tophi were significantly higher (p<0.05) in gout patients with bone erosion than in those without bone erosion. Longer disease duration (OR=1.11, 95% CI: 1.00-1.24, p<0.05) and increased tissue urate levels (OR=1.01, 95% CI: 1.00-1.02, p<0.05) were independently associated with bone erosion. Tissue urate levels at the MSU-bone interface were correlated with the presence of tophi (r=0.62, p<0.001), bone erosion (r=0.51, p<0.001), renal calculus (r=0.24, p=0.03), and serum uric acid levels (r=0.23, p=0.03). CONCLUSION This study found that longer disease duration and elevated tissue urate concentrations at the MSU-bone interface were associated with bone erosion in patients with gout.
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Affiliation(s)
- Xiaofei Liu
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Xiaohuan Zhang
- Department of Radiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Shiyan Mo
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China
| | - Dongfeng Liang
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Department of Rheumatology and Immunology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Baige Li
- Department of Radiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jian Zhu
- Department of Rheumatology and Immunology, Hainan Hospital, Chinese PLA General Hospital, Sanya, Hainan, China.,Department of Rheumatology and Immunology, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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21
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Feng W, Xiong G. [Clinical classification and treatment experience of wrist gouty arthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1411-1416. [PMID: 34779166 DOI: 10.7507/1002-1892.202103043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the clinical characteristics, clinical classification, and treatment of wrist gouty arthritis. Methods The clinical data of 24 patients with wrist gouty arthritis and complete follow-up between April 2011 and August 2020 were retrospectively analyzed. There were 21 males and 3 females; the first onset age was 21-72 years, with a median age of 50 years. There were 15 cases of simple wrist joint disease, and 9 cases of other joints (hand, knee, ankle, metatarsophalangeal joint) involvement; 19 cases of wrist joint as the first site. Except for 1 patient with a medical history of 21 years, the time from onset to diagnosis in the remaining 23 patients was 7 days to 9 years, with a median time of 2 months. According to the clinical manifestations, imaging manifestations, lesion range, and intraoperative wrist arthroscopy manifestations of wrist gouty arthritis, they were classified into 5 types from mild to severe. Among the 24 patients, 13 were type Ⅰ, 2 were type ⅡA, 3 were type ⅡB, 2 were type ⅢA, 3 were type Ⅳ, and 1 was type Ⅴ. The time from first onset to diagnosis for type Ⅰ and type Ⅱ patients was (12.7±40.1) months, and for type Ⅲ-Ⅴ patients was (152.0± 88.5) months, the difference was significant ( t=-4.355, P=0.001). Thirteen patients with type Ⅰ received conservative treatment (including diet, exercise, lifestyle intervention, and medication), and 11 patients with type Ⅱ-Ⅴ received surgical treatment (including 1 case of arthroscopic synovial membrane and gout crystal clearing, 1 case of ligament repair, 5 cases of lesion debridement/artificial bone grafting and filling, 3 cases of wrist fusion, and 1 case of tophicectomy). Before and after treatment, the visual analogue scale (VAS) score was used to evaluate the improvement of wrist joint pain; and the range of motion of the wrist joint (including palmar flexion, dorsal extension, radial deviation, and ulnar deviation) was evaluated. Results Thirteen conservatively treated patients were followed up 10 months to9 years, with an average of 2.2 years. The VAS scores before treatment and at last follow-up were 6.8±0.7 and 2.9±0.9, respectively, and the difference was significant ( t=12.309, P=0.000). During follow-up, there was no wrist bone and wrist joint damage; wrist joint range of motion basically reached normal. At last follow-up, the wrist joint palmar flexion, dorsal extension, radial deviation, and ulnar deviation significantly improved when compared with the values before treatment ( P<0.05). Eleven surgically treated patients were followed up 5 months to 9 years, with an average of 4.9 years. The swelling and pain of all patients fully relieved, and the VAS scores were 7.3±0.8 before operation, 2.7±0.6 at 1 month after operation, and 2.5±0.6 at last follow-up, which significantly improved after operation ( P<0.05); there was no significant difference between 1 month after operation and last follow-up ( P>0.05). Excluded 3 patients who underwent wrist fusion, the other 8 patients had significantly improved wrist joint palmar flexion, dorsal extension, radial deviation, and ulnar deviation at last follow-up ( P<0.05). The patient's subjective satisfaction with the surgical results reached 100%. Conclusion A missed diagnosis or misdiagnosis of wrist gouty arthritis will greatly damage the wrist stability and functions. Early and proper interventions can effectively retard the progress of the disease. For the late-stage cases, a staged surgical protocol is recommended.
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Affiliation(s)
- Wei Feng
- Department of Hand Surgery, Beijing Jishuitan Hostpital, Beijing, 100035, P.R.China.,Department of Orthopedics, Baoding No.1 Hospital of Traditional Chinese Medicine, Baoding Hebei, 071000, P.R.China
| | - Ge Xiong
- Department of Hand Surgery, Beijing Jishuitan Hostpital, Beijing, 100035, P.R.China
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22
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Khanna I, Pietro R, Ali Y. What Has Dual Energy CT Taught Us About Gout? Curr Rheumatol Rep 2021; 23:71. [PMID: 34259946 DOI: 10.1007/s11926-021-01035-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF THE REVIEW Dual energy computed tomography (DECT) scan has emerged as a useful diagnostic tool in the diagnosis of gout over recent years. Here, we review the role of DECT in the context of typical and atypical gout, including its role in identifying extra-articular monosodium urate (MSU) deposition. RECENT FINDINGS DECT has been found to be more accurate than ultrasound in detecting extra-articular MSU deposition in soft tissue. It has the ability to identify axial MSU deposition in gout patients with non-specific back pain. For individuals with no other clear etiology, this potentially implicates MSU as the cause of the pain. DECT also has the ability to detect vascular MSU deposition. This correlates with high coronary calcium scores and elevated Framingham cardiovascular risk. DECT continues to aid our understanding of articular and extra-articular MSU deposition, including the role of vascular MSU deposition on cardiovascular health. Not only does it allow quantification of urate burden but it can also potentially avoid invasive diagnostic procedures. The limitations and advantages of DECT are further explored in this article.
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Affiliation(s)
- Ira Khanna
- Division of Rheumatology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA.
| | - Rebecca Pietro
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai West, New York, NY, USA
| | - Yousaf Ali
- Division of Rheumatology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
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23
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Abdellatif W, Ding J, Khorshed D, Shojania K, Nicolaou S. Unravelling the mysteries of gout by multimodality imaging. Semin Arthritis Rheum 2021; 50:S17-S23. [PMID: 32620197 DOI: 10.1016/j.semarthrit.2020.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gout is a common inflammatory arthritis that manifests as an aggregate of variably symptomatic monosodium urate crystals (MSU) in the joints and surrounding tissues in addition to multisystem involvement such as genitourinary and cardiovascular systems. In recent decades, there has been a documented increase in the prevalence and incidence of gout. Risk factors for gout include obesity, dietary influences, hypertension, renal impairment, and diuretic use. A prompt diagnosis followed by uric acid lowering treatment prior to the onset of bone destruction is the goal in any suspected case of gout. Advanced imaging modalities, such as dual energy computed tomography (DECT) and ultrasonography (US), employed for the diagnosis of gout are each accompanied by advantages and disadvantages. Conventional radiography (CR), although useful in visualizing joint erosions and mineralization, is limited in its ability to diagnose gout flare. Although synovial fluid aspiration remains the gold standard for MSU crystal visualization, less-invasive imaging modalities are preferred to avoid potential complications. DECT and US in particular are useful in the diagnosis of gout. In this review, we will discuss the current state and role of imaging in the detection of gout.
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Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, Department of Emergency and Trauma Radiology, University of British Columbia/ Vancouver General Hospital, 899W 12th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Jeffrey Ding
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Kam Shojania
- Department of Rheumatology, University of British Columbia, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Department of Radiology, Department of Emergency and Trauma Radiology, University of British Columbia/ Vancouver General Hospital, 899W 12th Ave, Vancouver, BC V5Z 1M9, Canada.
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24
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Espejo D, Dearing E, Ogle KY, Portela M, Boniface KS. Images in Primary Care Medicine: Point-of-Care Ultrasound in Gout. Cureus 2021; 13:e15096. [PMID: 34155462 PMCID: PMC8211301 DOI: 10.7759/cureus.15096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Gout is the most common crystal arthropathy and is frequently diagnosed and managed by primary care physicians. Point-of-care ultrasound (POCUS) is a valuable tool to aid in the diagnosis of gout via the identification of the double contour sign, aggregates of crystals, tophi, and erosions. In addition, POCUS can aid in the management of gout by recognizing early signs of gout, monitoring the effectiveness of urate-lowering therapy, and guiding aspiration and corticosteroid injection.
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Affiliation(s)
- Dennis Espejo
- Family Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elizabeth Dearing
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kathleen Y Ogle
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Maria Portela
- Family Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Keith S Boniface
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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25
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Cheung TT, Chan HKY, Lee GKW. An Unusual Presentation of Gout Involving the Ankle Ligaments. JOURNAL OF CLINICAL RHEUMATOLOGY AND IMMUNOLOGY 2020. [DOI: 10.1142/s2661341720720025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gout is the most common inflammatory arthritis due to deposition of monosodium urate (MSU) crystals in joints and connective tissues. In contrast to joint disease, the majority of extra-articular involvement remains asymptomatic in patients with gout. Achilles tendon is the most common site of involvement and the inflammation elicited by MSU crystals can be falsely attributed to injury or overuse. In addition, tendon or ligament damage secondary to MSU crystal deposition can lead to ligament tear or tendon rupture. However, the diagnosis of gout in patients with extra-articular involvement is often delayed or even missed because tissue sampling is not feasible in routine clinical practice. Advanced imaging techniques using ultrasound and dual-energy computer tomography (DECT) can detect MSU crystal deposition in a non-invasive manner and confirm the diagnosis of gout in patients with extra-articular involvement. The following case demonstrates an atypical presentation of gout causing multiple ligament tears in the ankle and highlights the role of DECT in the diagnosis of gout with extra-articular involvement.
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Affiliation(s)
- Tommy Tsang Cheung
- Department of Medicine, Rheumatology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Helen Ka Yan Chan
- Department of Medicine, Rheumatology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Gavin Ka Wing Lee
- Department of Medicine, Rheumatology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, China
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26
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Hammer HB, Karoliussen L, Terslev L, Haavardsholm EA, Kvien TK, Uhlig T. Ultrasound shows rapid reduction of crystal depositions during a treat-to-target approach in gout patients: 12-month results from the NOR-Gout study. Ann Rheum Dis 2020; 79:1500-1505. [PMID: 32669301 DOI: 10.1136/annrheumdis-2020-217392] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/06/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES As ultrasound is sensitive for detecting crystal depositions in patients with gout, our objectives were to explore the main locations for depositions and the extent of dissolution of depositions during a treat-to-target approach with urate lowering treatment (ULT) in patients with gout. METHODS Patients with a recent flare of gout were consecutively included in this single-centre study and managed by a treat-to-target approach with ULT. All patients were assessed at baseline, 3, 6 and 12 months including bilateral ultrasound examinations of joints/tendons/entheses of hands, elbows, knees, ankles and feet. A new semiquantitative scoring system of 0-3 of elementary lesions (double contour (DC), tophi and aggregates) was applied to quantify the amount of depositions during the follow-up. RESULTS 209 of the patients were evaluated with ultrasound at baseline (mean (SD) age 56.4 (13.8) years and disease duration 7.9 (7.7) years, 95.2% men). The serum urate levels decreased from baseline to 12 months (mean (SD) 500 (77) to 312 (49) µmol/L) (p<0.001)). The first metatarsophalangeal joint was the most frequent location for all the elementary lesions and erosions were associated with higher levels of crystal depositions. From baseline to 12 months, mean sum scores decreased for DC (4.3 to 1.3), tophi (6.5 to 3.8) and aggregates (9.3 to 6.7) (p<0.001 for all), with DC being most sensitive to change. CONCLUSIONS The ultrasound scoring system for crystal depositions was sensitive to change and showed that a treat-to-target approach with ULT resulted in significant reductions of all the depositions, most extensively for DC.
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Affiliation(s)
- Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | | | - Lene Terslev
- Department of Rheumatology, Glostrup University Hospital, Copenhagen, Denmark
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Sykehus, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
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27
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Schwabl C, Taljanovic M, Widmann G, Teh J, Klauser AS. Ultrasonography and dual-energy computed tomography: impact for the detection of gouty deposits. Ultrasonography 2020; 40:197-206. [PMID: 33307617 PMCID: PMC7994744 DOI: 10.14366/usg.20063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/02/2020] [Indexed: 12/27/2022] Open
Abstract
Ultrasonography (US) and dual-energy computed tomography (DECT) are useful and sensitive diagnostic tools to identify monosodium urate deposits in joints and soft tissues. The purpose of this review is to overview the imaging findings obtained by US and DECT in patients with gout, to understand the strengths and weaknesses of each imaging modality, and to evaluate the added value of using both modalities in combination.
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Affiliation(s)
- Christoph Schwabl
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Mihra Taljanovic
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ, USA
| | - Gerlig Widmann
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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28
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Filippucci E, Reginato AM, Thiele RG. Imaging of crystalline arthropathy in 2020. Best Pract Res Clin Rheumatol 2020; 34:101595. [PMID: 33012644 DOI: 10.1016/j.berh.2020.101595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Crystal-related arthropathies are the result of crystal deposition in joint and periarticular soft tissues. Identification of urate crystals is mandatory to distinguish gout from other crystalline arthropathies, including calcium pyrophosphate dihydrate and basic calcium phosphate crystal deposition diseases. ACR/EULAR classification criteria for gout included dual-energy computed tomography and ultrasound with equal impact to the final score. Different diagnostic strengths of these imaging modalities depend on disease duration and scanned anatomic site. While ultrasound has been indicated as the first-choice imaging technique, especially in the early stages of the disease, dual-energy computed tomography has shown to be highly specific, allowing the detection of crystal deposits in anatomic sites not accessible by ultrasound, such as the spine. At the spinal level, MRI findings are usually nonspecific. Finally, there is preliminary evidence that at the knee, dual-energy computed tomography may discriminate calcium pyrophosphate dihydrate from basic calcium phosphate crystal deposits.
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Affiliation(s)
- Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy.
| | - Anthony M Reginato
- Division of Rheumatology, Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Ralf G Thiele
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester, Rochester, NY, USA.
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Abstract
Gout is the most common inflammatory arthritis in the US, affecting 3.9% of the population. Although many effective gout therapies are available for acute flares and chronic management, it is suboptimally treated worldwide, and recurrent gout flares can cause significant pain and irreversible joint damage.
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30
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Gout of ankle and foot: DECT versus US for crystal detection. Clin Rheumatol 2020; 40:1533-1537. [PMID: 32880052 DOI: 10.1007/s10067-020-05378-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare dual-energy computed tomography (DECT) and ultrasound (US) in detecting monosodium urate (MSU) crystals in the ankle and foot in patients with acute gouty arthritis. METHODS Bilateral ankle and foot were examined by DECT and US and the differences between the findings were compared. RESULTS A total of 50 patients underwent DECT and US examinations. At the patient level, the overall positivity of crystal deposition detected by DECT was higher than that by US (92% vs 68%, P = 0.005). The agreement of detecting crystal deposition between DECT and US was not very strong (К = 0.44, P = 0.003). At different joint/area levels, there were significant differences between the two examinations in the area of the dorsum (36% vs 12%, P = 0.009) and metatarsal bone (34% vs 12%, P = 0.017), but the sensitivity of DECT and US was similar in the first metatarsophalangeal joint (MTP) and ankle areas (P>0.05). Agreement between the two examinations in the ankle and first MTP was very strong (К = 0.86, P < 0.001; К = 0.79, P < 0.001, respectively). However, agreement between the two examinations in other joints/areas was poor. CONCLUSION These findings indicated that DECT should be the first choice for acute gouty arthritis in patients with ankle and foot involvement. Key Points • There is little data regarding DECT and US in detecting MSU crystals in the ankle and foot in patients with acute gouty arthritis. • The overall positivity of crystal deposition detected by DECT was higher than that by US, but the sensitivity of DECT and US was similar in the first metatarsophalangeal joint (MTP) and ankle areas. • Agreement between the two examinations in the ankle and first MTP was very strong; however, agreement between the two examinations in other joints/areas was poor.
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Carotti M, Salaffi F, Filippucci E, Aringhieri G, Bruno F, Giovine S, Gentili F, Floridi C, Borgheresi A, De Filippo M, Masciocchi C, Barile A, Giovagnoni A. Clinical utility of Dual Energy Computed Tomography in gout: current concepts and applications. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:116-124. [PMID: 32945286 PMCID: PMC7944678 DOI: 10.23750/abm.v91i8-s.9942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022]
Abstract
Gout is the most common inflammatory arthritis and is increasing in prevalence and incidence in many countries worldwide. Dual Energy Computed Tomography (DECT) has a high diagnostic accuracy in established gout, but its diagnostic sensitivity is low in subjects with recent-onset gout. A meta-analysis of 17 studies showed a pooled sensitivity and specificity of 0.85 and 0.88, respectively. DECT is a useful diagnostic tool for patients with contraindications for joint aspiration or for those who refuse joint aspiration. This article aims to give an up to date review and summary of existing literature on the role and accuracy of DECT in the imaging of gout. (www.actabiomedica.it)
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Affiliation(s)
- Marina Carotti
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi -Salesi"- Universiy Politecnica Marche - Via Conca 71, 60126 Ancona, AN, Italy. .
| | - Fausto Salaffi
- Rheumatological Clinic, Department of Molecular and Clinical Sciences, University Politecnica Marche - Ancona, Italy.
| | - Emilio Filippucci
- Rheumatological Clinic, Department of Molecular and Clinical Sciences, University Politecnica Marche - Ancona, Italy.
| | - Giacomo Aringhieri
- Radiologia Diagnostica ed Interventistica, Dipartimento di ricercar Traslazionale e Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy.
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy.
| | - Sabrina Giovine
- Department of Radiology, SG Moscati Hospital, ASL Caserta, Aversa, Caserta, Italy.
| | - Francesco Gentili
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Chiara Floridi
- University Politecnica delle Marche, Department of Clinical Special and Dental Sciences, Ancona, Italy.
| | - Alessandra Borgheresi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi -Salesi"- University Politecnica Marche - Ancona, Italy.
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy.
| | - Antonio Barile
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | - Andrea Giovagnoni
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi -Salesi"- University Politecnica Marche - Ancona, Italy.
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Urits I, Smoots D, Anantuni L, Bandi P, Bring K, Berger AA, Kassem H, Ngo AL, Abd-Elsayed A, Manchikanti L, Urman R, Kaye AD, Viswanath O. Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review. Pain Ther 2020; 9:129-142. [PMID: 32100225 PMCID: PMC7203307 DOI: 10.1007/s40122-020-00158-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION This compilation presents a comprehensive review of the literature on common chronic pain conditions of the hand. It briefly presents these common conditions with their biological background, diagnosis, and common management options. It then presents and compares the latest literature available for injection techniques to treat these diagnoses and compares the available evidence. METHODS A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms "hand pain", "injection techniques", "steroid injection", "chronic pain", "osteoarthritis", "rheumatoid arthritis", "carpal tunnel syndrome", "De Quervain's tenosynovitis", "ganglion cyst", "gout", "Raynaud's", and "stenosing tenosynovitis". RESULTS Hand pain is a common condition with 9.7% prevalence in men and 21.6% in women and can cause significant morbidity and disability. It also carries a significant cost to the individuals and the healthcare system, totaling in $4 billion dollars in 2003. Injection therapy is an alternative when conservative treatment fails. Osteoarthritis is the most common chronic hand pain syndrome and affects about 16% of the population. Its mechanism is largely mechanic, and as such, there is controversy if steroid injections are of benefit. Hyaluronic acid (HA) appears to provide substantial relief of pain and may increase functionality. More studies of HA are required to make a definite judgment on its efficacy. Similarly, steroid ganglion cyst injection may confer little benefit. Carpal tunnel syndrome is a compressive neuropathy, and only temporarily relieved with injection therapy. US-guidance provides significant improvement and, while severe cases may still require surgery, can provide a valuable bridge therapy to surgery when conservative treatment fails. Similar bridging treatments and increased efficacy under US-guidance are effective for stenosing tenosynovitis ("trigger finger"), though, interestingly, inflammatory background is associated with decreased effect in this case. When the etiology of the pain is inflammatory, such as in RA, corticosteroid (CS) injections provide significant pain relief and increased functionality. They do not, however, change the course of disease (unlike DMARDs). Another such example is De-Quervain tenosynovitis that sees good benefit from CS injections, and an increased efficacy with US-guidance, and similarly are CS injections for gout. For Raynaud's phenomenon, Botox injections have encouraging results, but more studies are needed to determine safety and efficacy, as well as the possible difference in effect between primary and secondary Raynaud's. CONCLUSIONS Chronic hand pain is a prevalent and serious condition and can cause significant morbidity and disability and interferes with independence and activities of daily living. Conservative treatment remains the first line of treatment; however, when first-line treatments fail, steroid injections can usually provide benefit. In some cases, HA or Botox may also be beneficial. US-guidance is increasing in hand injection and almost ubiquitously provides safer, more effective injections. Hand surgery remains the alternative for refractory pain.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Daniel Smoots
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Lekha Anantuni
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Prudhvi Bandi
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Katie Bring
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Amnon A Berger
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Anh L Ngo
- Department of Pain Medicine, Pain Specialty Group, Newington, NH, USA
- Harvard Medical School, Boston, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Richard Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Liu Y, Li X, Jiao G, Zhou P, Li Z. Multilevel Lumbar Stenosis Caused by Large Tophi Involving Both Spinal Canal and Posterior Spinal Elements: A Rare Case Report and Literature Review. J Med Cases 2019; 10:333-337. [PMID: 34434303 PMCID: PMC8383701 DOI: 10.14740/jmc3392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 11/27/2022] Open
Abstract
Tophus is a characteristic manifestation of gout entering the chronic phase, which usually deposits in the joints of the extremities, skin mucosa, etc. A gout tophus that involves the spine causing spinal stenosis is rare and it can be misdiagnosed as a spinal tumor preoperatively. We report the case of a 35-year-old man who presented with lumbar stenosis symptoms, and suffered multiple-site gout tophi involvement throughout his body. Radiographic examinations showed that the large tophi infiltrated the posterior elements of the spine and encroached the lumbar spinal canal, resulting in neurologic compression from the second to the fifth lumbar level. Urate could be observed on a dual-energy computed tomography. A posterior-based procedure was performed to eradicate the tophi and stabilize the spine. Finally, urate crystal was confirmed by postoperative pathological examination. Here, the clinical manifestations, radiological, pathological and surgical features for this case are reported.
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Affiliation(s)
- Yang Liu
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
| | - Xueshi Li
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
| | - Genlong Jiao
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
| | - Pan Zhou
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
| | - Zhizhong Li
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
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Development and validation of a quantitative method for estimation of the urate burden in patients with gouty arthritis using dual-energy computed tomography. Eur Radiol 2019; 30:404-412. [DOI: 10.1007/s00330-019-06350-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/15/2019] [Accepted: 06/28/2019] [Indexed: 12/27/2022]
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Lee SK, Jung JY, Jee WH, Lee JJ, Park SH. Combining non-contrast and dual-energy CT improves diagnosis of early gout. Eur Radiol 2018; 29:1267-1275. [PMID: 30225600 DOI: 10.1007/s00330-018-5716-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/17/2018] [Accepted: 08/14/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine the incremental value of non-contrast CT (NCCT) on dual-energy CT (DECT) in symptomatic first metatarsophalangeal (MTP) joints in early gout. METHODS One hundred and fifteen painful joints were consecutively enrolled and gout was diagnosed based on the 2015 EULAR/ACR criteria and/or arthrocentesis. Two readers independently evaluated DECT alone and combined NCCT and DECT (NCCT+DECT) based on four semiquantitative scales. Sensitivities and specificities were compared using McNemar's test. AUC was compared. RESULTS Of the 115 joints, 72 were defined as an early gout group and 43 as a gout-negative group after exclusion. The sensitivity and specificity for the early gout group on DECT alone were as followed: reader 1 - 52.8% and 100.0% and reader 2 - 51.4% and 100.0%. NCCT+DECT results were as follows: reader 1 - 79.2% and 93.0% and reader 2 - 79.2% and 95.3%. AUC was significantly higher in NCCT+DECT compared to that in DECT alone for the early gout group (0.888 vs. 0.774 for reader 1, p = 0.0004; 0.896 vs. 0.816 for reader 2, p = 0.0142). The false-negative cases on DECT occurred more frequently with the first-onset gout, and tended to be affected by a longer duration of symptoms in the post-hoc analysis. CONCLUSION The combined analysis of NCCT and DECT improves diagnostic capabilities in symptomatic early gout involving the first MTP joint. KEY POINTS • MSU crystal depositions in early gout may be seen on non-contrast CT, while still being undetectable by DECT. • Combining non-contrast CT and DECT improves detection of early gout. • False negatives of DECT are more common than previously reported in cases of first-onset gout.
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Affiliation(s)
- Seul Ki Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Department of Radiology, Dongguk University Ilsan Hospital, Gyenggi-do, 10326, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jennifer Jooha Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
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