TY - JOUR
T1 - Identification of intraarticular and periarticular uric acid crystals with dual-energy CT
T2 - Initial evaluation
AU - Glazebrook, Katrina N.
AU - Guimarães, Luis S.
AU - Murthy, Naveen S.
AU - Black, David F.
AU - Bongartz, Tim
AU - Manek, Nisha J.
AU - Leng, Shuai
AU - Fletcher, Joel G.
AU - McCollough, Cynthia H.
PY - 2011/11
Y1 - 2011/11
N2 - Purpose: To estimate the accuracy, sensitivity, specificity, and interobserver agreement of dual-energy computed tomography (CT) in detection of uric acid crystals in joints or periarticular structures in patients with arthralgia and patients suspected of having gout, with joint aspiration results as reference standard . Materials and Methods: With institutional review board approval, patient consent, and HIPAA compliance, 94 patients (age range, 29-89 years) underwent dual-source, dual-energy (80 and 140 kVp) CT of a painful joint. A material decomposition algorithm was used to identify uric acid. Two blinded musculoskeletal radiologists evaluated the dual-energy CT images and classifi ed the examination findings as positive or negative for the presence of uric acid crystals. Reference standard was the result of joint aspiration. Results: Forty-three of 94 patients (46%) underwent attempted joint aspiration within 1 month of dual-energy CT. Aspiration was successful in 31 of 43 patients (72%). In 12 of 31 patients (39%), uric acid crystals were identified at joint aspiration; in 19 patients, they were not. Readers 1 and 2 had no false-negative findings for uric acid at dual-energy CT. Sensitivity was 100% (12 of 12; 95% confidence interval (CI): 74%, 100%) for both readers. Specificity was 89% (17 of 19; 95% CI: 67%, 99% ) for reader 1 and 79% (15 of 19; 95% CI: 54%, 94%) for reader 2, with nearperfect agreement between the readers(κ = 0.87; range, 0.70-1.00) in the 31 patients who underwent aspiration. Conclusion: Initial retrospective assessment suggests that dual-energy CT is a sensitive, noninvasive, and reproducible method for identifying uric acid deposits in joints and periarticular soft tissues in patients suspected of having gout.
AB - Purpose: To estimate the accuracy, sensitivity, specificity, and interobserver agreement of dual-energy computed tomography (CT) in detection of uric acid crystals in joints or periarticular structures in patients with arthralgia and patients suspected of having gout, with joint aspiration results as reference standard . Materials and Methods: With institutional review board approval, patient consent, and HIPAA compliance, 94 patients (age range, 29-89 years) underwent dual-source, dual-energy (80 and 140 kVp) CT of a painful joint. A material decomposition algorithm was used to identify uric acid. Two blinded musculoskeletal radiologists evaluated the dual-energy CT images and classifi ed the examination findings as positive or negative for the presence of uric acid crystals. Reference standard was the result of joint aspiration. Results: Forty-three of 94 patients (46%) underwent attempted joint aspiration within 1 month of dual-energy CT. Aspiration was successful in 31 of 43 patients (72%). In 12 of 31 patients (39%), uric acid crystals were identified at joint aspiration; in 19 patients, they were not. Readers 1 and 2 had no false-negative findings for uric acid at dual-energy CT. Sensitivity was 100% (12 of 12; 95% confidence interval (CI): 74%, 100%) for both readers. Specificity was 89% (17 of 19; 95% CI: 67%, 99% ) for reader 1 and 79% (15 of 19; 95% CI: 54%, 94%) for reader 2, with nearperfect agreement between the readers(κ = 0.87; range, 0.70-1.00) in the 31 patients who underwent aspiration. Conclusion: Initial retrospective assessment suggests that dual-energy CT is a sensitive, noninvasive, and reproducible method for identifying uric acid deposits in joints and periarticular soft tissues in patients suspected of having gout.
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U2 - 10.1148/radiol.11102485
DO - 10.1148/radiol.11102485
M3 - Article
C2 - 21926378
AN - SCOPUS:80054791612
SN - 0033-8419
VL - 261
SP - 516
EP - 524
JO - Radiology
JF - Radiology
IS - 2
ER -