Is dual‐energy computed tomography able to identify early calcium crystal deposition in the knees of calcium pyrophosphate deposition patients?

2020 ◽  
Author(s):  
Jean‐François Budzik ◽  
Claire Marzin ◽  
Julie Legrand ◽  
Laurène Norberciak ◽  
Fabio Becce ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Calcium Pyrophosphate ◽  
Dual Energy ◽  
Crystal Deposition ◽  
Dual Energy Computed Tomography

scholarly journals Dual-energy computed-tomography-based discrimination between basic calcium phosphate and calcium pyrophosphate crystal deposition in vivo

2020 ◽  
Vol 12 ◽  
pp. 1759720X2093606 ◽  
Author(s):  
Tristan Pascart ◽  
Guillaume Falgayrac ◽  
Laurène Norberciak ◽  
Clément Lalanne ◽  
Julie Legrand ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Raman Spectroscopy ◽  
Calcium Phosphate ◽  
Calcium Pyrophosphate ◽  
Dual Energy ◽  
Basic Calcium Phosphate ◽  
Crystal Deposition ◽  
Dual Energy Computed Tomography

Background: Dual-energy computed tomography (DECT) is being considered as a non-invasive diagnostic and characterization tool in calcium crystal-associated arthropathies. Our objective was to assess the potential of DECT in distinguishing between basic calcium phosphate (BCP) and calcium pyrophosphate (CPP) crystal deposition in and around joints in vivo. Methods: A total of 13 patients with calcific periarthritis and 11 patients with crystal-proven CPPD were recruited prospectively to undergo DECT scans. Samples harvested from BCP and CPP calcification types were analyzed using Raman spectroscopy and validated against synthetic crystals. Regions of interest were placed in BCP and CPP calcifications, and the following DECT attenuation parameters were obtained: CT numbers (HU) at 80 and 140 kV, dual-energy index (DEI), electron density (Rho), and effective atomic number ( Zeff). These DECT attenuation parameters were compared and validated against crystal calibration phantoms at two known equal concentrations. Receiver operating characteristic (ROC) curves were plotted to determine the highest accuracy thresholds for DEI and Zeff. Results: Raman spectroscopy enabled chemical fingerprinting of BCP and CPP crystals both in vitro and in vivo. DECT was able to distinguish between HA and CPP in crystal calibration phantoms at two known equal concentrations, most notably by DEI (200 mg/cm3: 0.037 ± 0 versus 0.034 ± 0, p = 0.008) and Zeff (200 mg /cm3: 9.4 ± 0 versus 9.3 ± 0, p = 0.01) analysis. Likewise, BCP calcifications had significantly higher DEI (0.041 ± 0.005 versus 0.034 ± 0.005, p = 0.008) and Zeff (9.5 ± 0.2 versus 9.3 ± 0.2, p = 0.03) than CPP crystal deposits with comparable CT numbers in patients. With an area under the ROC curve of 0.83 [best threshold value = 0.0 39, sensitivity = 90. 9% (81.8, 97. 7%), specificity = 64.6% (50.0, 64. 6%)], DEI was the best parameter in distinguishing between BCP and CPP crystal depositions. Conclusion: DECT can help distinguish between crystal-proven BCP and CPP calcification types in vivo and, thus, aid in the diagnosis of challenging clinical cases, and in the characterization of CPP and BCP crystal deposition occurring in osteoarthritis.

scholarly journals Distribution of bony erosions in feet and performance of two bone erosion scores: A dual-energy computed tomography study of 61 patients with gout

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259194
Author(s):  
Amandine Chabernaud Negrier ◽  
Lokmane Taihi ◽  
Eric Vicaut ◽  
Pascal Richette ◽  
Thomas Bardin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Erosion ◽  
Intraclass Correlation ◽  
Metatarsophalangeal Joint ◽  
Dual Energy ◽  
Radiology Department ◽  
Crystal Deposition ◽  
First Metatarsophalangeal Joint ◽  
Dual Energy Computed Tomography ◽  
Bone Erosions

Objectives To assess the distribution of bone erosions and two erosion scores in the feet of patients with gout and analyze the association between erosion scores and monosodium urate (MSU) crystal deposition using dual-energy computed tomography (DECT). Materials and methods We included all patients who underwent DECT of both feet between 2016 and 2019 in our radiology department, with positive detection of MSU deposits. Data on sex, age, treatment, serum urate, and DECT urate volumes were obtained. CT images were analyzed to score bone erosions in 31 sites per foot by using the semi-quantitative method based on the Rheumatoid Arthritis MRI Scoring (RAMRIS) system and the Dalbeth-simplified score. Reproducibility for the two scores was calculated with intraclass correlation coefficients (ICCs). Correlations between clinical features, erosion scores and urate crystal volume were analyzed by the Spearman correlation coefficient (r). Results We studied 61 patients (mean age 62.0 years); 3,751 bones were scored. The first metatarsophalangeal joint and the midfoot were the most involved in terms of frequency and severity of bone erosions. The distribution of bone erosions was not asymmetrical. The intra- and inter-observer reproducibility was similar for the RAMRIS and Dalbeth-simplified scores (ICC 0.93 vs 0.94 and 0.96 vs 0.90). DECT urate volume was significantly correlated with each of the two erosion scores (r = 0.58–0.63, p < 0.001). There was a high correlation between the two scores (r = 0.96, p < 0.001). Conclusions DECT demonstrates that foot erosions are not asymmetric in distribution and predominate at the first ray and midfoot. The two erosion scores are significantly correlated with DECT urate volume. An almost perfect correlation between the RAMRIS and Dalbeth-simplified scores is observed.

Dual-Energy Computed Tomography for Detection and Characterization of Monosodium Urate, Calcium Pyrophosphate, and Hydroxyapatite

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anna Døssing ◽  
Felix Christoph Müller ◽  
Fabio Becce ◽  
Lisa Stamp ◽  
Henning Bliddal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Calcium Pyrophosphate ◽  
Dual Energy ◽  
Monosodium Urate ◽  
Dual Energy Computed Tomography

TO EVALUATE DECT’S ROLE IN GOUT AND EXAMINE THE RELATIONSHIP WITH CLINICAL AND PARACLINICAL

2019 ◽  
pp. 78-83
Author(s):  
Van Nam Tran ◽  
Tam Vo ◽  
Chi Cuong Nguyen ◽  
Nguyen Thanh Nhan Vo ◽  
Thanh Hai Phan
Keyword(s):  
Computed Tomography ◽  
Bone Structure ◽  
Multivariate Logistic Regression Analysis ◽  
Dual Energy ◽  
Original Research ◽  
Cross Sectional ◽  
Crystal Deposition ◽  
Dual Energy Computed Tomography ◽  
The Relationship ◽  
Urate Crystals

Background: To identify Urate crystals from synovial fluid under polarized microscopy is considered the gold standard in diagnosing Gout disease. However, it is not always possible to suck up enough fluid or in case of pain, it is impossible to suck the fluid. Dual-energy Computed Tomography (DECT) is a new tool for diagnosing Gout disease. DECT shows the deposition of urate crystals and bone structure images using different display colors. However, there is no agreement from the research results in the world. In Vietnam, no original research has been published. Objective: To evaluate DECT’s role in Gout and examine the relationship with clinical and paraclinical factors. Methods: A cross-sectional study was conducted in patients who visited the Hoa Hao-Medic clinic in Ho Chi Minh City. Gout disease is diagnosed with clinical and paraclinical criteria; and have DECT results. The cases were selected continuously, there were no cases of losing samples. Multivariate logistic regression analysis was used to determine the independent association between clinical and paraclinical variables with DECT images. Results: 61 out of 80 Gout patients with DECT positive accounted for 77.25%, There was an association between DECT and number of Gout attacks (> 3 times), duration of illness (> 36 months), tophi seeds. No correlation was found between clinical variables and background characteristics in the study. In the subclinical, urate crystal deposition images show a clear imprint on goute disease, while other variables do not find expression. Conclusion: DECT is closely related to the frequency of gout attacks, disease duration and tophi. Gout disease is a consequence of lifestyle behaviors, inappropriate eating habits, and exposure to risk factors in life. Key words: DECT (Dual-energy Computed Tomography), Hoa Hao-Med, Gout

scholarly journals OP0318 THE ROLE OF DUAL ENERGY COMPUTED TOMOGRAPHY (DECT) IN THE DIFFERENTIATION OF GOUT AND CALCIUM PYROPHOSPHATE DEPOSITION DISEASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 196.2-196 ◽  
Author(s):  
D. Kravchenko ◽  
P. Karakostas ◽  
P. Brossart ◽  
C. Behning ◽  
C. Meyer ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Uric Acid ◽  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Calcium Pyrophosphate ◽  
Dual Energy ◽  
Laboratory Parameters ◽  
Dual Energy Computed Tomography ◽  
Non Invasive ◽  
Calcium Pyrophosphate Deposition Disease

Background:Differentiation of gout and calcium pyrophosphate deposition disease (CPPD) is sometimes difficult as patients often present with a similar clinical picture. Arthrocentesis and subsequent polarization microscopy (PM) remains the gold standard but novel diagnostic approaches such as non-invasive dual energy computed tomography (DECT) have recently been validated for gout. Currently, limited data is available on DECT in patients with CPPD.Objectives:To analyse the diagnostic impact of DECT in gout and CPPD when compared to the gold standard of PM. We further compared the results of PM to ultrasound (US), conventional radiographs (CR), and suspected clinical diagnosis (SCD). Additionally, 15 laboratory parameters were analysed.Methods:Twenty-six patients diagnosed with gout (n = 18) or CPPD (n = 8) who received a DECT and underwent arthrocentesis were included. Two independent readers assessed colour coded, as well as 80 and 120 kV DECT images for signs of monosodium urate (MSU) crystals or CPP deposition. US and CR from the patient’s initial visit along with the SCD were also compared to PM. US examinations were performed by certified musculoskeletal ultrasound specialists. The association of up to 15 laboratory parameters such as uric acid, thyroid stimulating hormone, and C-reactive protein (CRP) with the PM results was analysed.Results:Sensitivity of DECT for gout was 67% (95% CI 0.41-0.87) with a specificity of 88% (95% CI 0.47-1.0). Concerning CPPD, the sensitivity and specificity of DECT was 63% (95% CI 0.25-0.91) and 83% (95% CI 0.59-0.96) respectively. US had the highest sensitivity of 89% (95% CI 0.65-0.99) with a specificity of 75% (95% CI 0.35-0.97) for gout, while the sensitivity and specificity for CPPD were 88% (95% CI 0.47-1.0) and 89% (95% CI 0.65-0.99) respectively. The SCD had the second highest sensitivity for gout at 78% (95% CI 0.52-0.94) with a comparable sensitivity of 63% (95% CI 0.25-0.92) for CPPD. Uric acid levels were elevated in 33% of gout patients and 25% of CPPD patients. While elevated CRP levels were observed in 59% of gout patients and in 88% of CPPD patients, none of the 15 analysed laboratory parameters were found to be significantly linked.Conclusion:DECT provides a non-invasive diagnostic tool for gout but might have a lower sensitivity than suggested by previous studies (67% vs 90%1). DECT sensitivity for CPPD was 63% (95% CI 0.25-0.91) in a sample group of eight patients. Both US and the SCD had higher sensitivities than DECT for gout and CPPD. Further studies with larger patient cohorts are needed in order to determine the diagnostic utility of DECT in CPPD.References:[1]Bongartz, Tim; Glazebrook, Katrina N.; Kavros, Steven J.; Murthy, Naveen S.; Merry, Stephen P.; Franz, Walter B. et al. (2015): Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. InAnnals of the rheumatic diseases74 (6), pp. 1072–1077. DOI: 10.1136/annrheumdis-2013-205095.Disclosure of Interests:None declared

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