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Dual energy computed tomography: a novel technique for diagnosis of gout
Author(s) -
Ahmad Zohra,
Gupta Arun Kumar,
Sharma Raju,
Bhalla Ashu Seith,
Kumar Uma,
Sreenivas V.
Publication year - 2016
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12874
Subject(s) - medicine , radiography , gout , gold standard (test) , confidence interval , radiology , computed tomography , nuclear medicine
Aim To evaluate the sensitivity and specificity of dual energy computed tomography ( DECT ) for diagnosing gout compared with a composite gold standard ( CGS ) comprising joint aspiration and/or American College of Rheumatology clinico‐radiographic criteria. Methods Ninety patients of suspected gout underwent radiography and DECT of bilateral feet and knees. Radiographs and non‐contrast CT ( NCCT ) were assessed for morphological characteristics, following which DECT was used to identify urate deposits. Results With CGS as a reference ( n = 90), sensitivity of radiographs was 15% (95% confidence interval [ CI ]: 6–27%) while specificity was 100% (95% CI : 90–100%). Sensitivity of NCCT was 26% (95% CI : 15–40%) while specificity was 97% (95% CI : 85–99%). Sensitivity of DECT was 82% (95% CI : 68–90%) while specificity was 89% (95% CI : 73–96%). Fifty‐five patients underwent joint aspiration. Sensitivity and specificity of radiographs and NCCT with aspiration as a reference ( n = 55) were not much different from that of CGS . However, DECT showed a higher sensitivity of 100% (95% CI : 86–100%) and a lower specificity of 48% (95% CI : 28–68%) with aspiration alone. Conclusions Dual energy computed tomography had higher sensitivity compared to conventional imaging with CGS as a reference; however, its specificity dropped with aspiration as a reference. It may be a useful adjunct for the diagnosis of gout, especially in the acute and inter‐critical stage.