Abstract

Objectives

To evaluate the ability of dual-energy computed tomography (DECT) to improve diagnostic discrimination between gout and other crystal arthropathies such as calcium pyrophosphate deposition disease (CPPD) of the wrist in a clinical patient population.

Materials and methods

This retrospective case-control study included 29 patients with either gout (case group; n = 9) or CPPD (control group; n = 20) who underwent DECT of the wrist for clinically suspected crystal arthropathy. Color-coded urate and enhanced calcium as well as virtual 120 kVe blended images were reconstructed from the DECT datasets. Two independent and blinded readers evaluated each reconstructed dataset for the presence of depositions in 17 predefined regions. Additionally, a global diagnosis was made first for 120 kVe images only, based solely on morphologic criteria, and subsequently for all reconstructed images.

Results

Sensitivity for the global diagnosis of gout was 1.0 (95% CI 0.63–1) for both DECT and 120 kVe images with specificities of 0.70 (95% CI 0.46–0.87) for DECT and 0.80 (95% CI 0.56–0.93) for 120 kVe images. Color-coded DECT images did not detect more depositions than monochrome standard CT images.

Conclusion

Discrimination of crystal arthropathies of the wrist is limited using DECT and primarily relying on color-coded images. Evaluation of morphologic criteria on standard CT images is essential for accurate diagnosis.

中文翻译：

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双能CT在区分手腕晶体沉积方面：它是否具有附加值？

摘要

目标

评估双能计算机断层扫描（DECT）改善痛风和其他晶体关节病（例如临床患者人群中手腕的焦磷酸钙沉积病（CPPD））的诊断区别的能力。

材料和方法

这项回顾性病例对照研究包括29名患有痛风（病例组；n  = 9）或CPPD（对照组；n  = 20）的患者，他们因临床怀疑为晶体关节炎而接受了腕部DECT检查。从DECT数据集重建了颜色编码的尿酸盐和增强钙以及虚拟的120 kVe混合图像。两名独立且不知情的读者评估了每个重建的数据集在17个预定义区域中沉积物的存在。此外，首先仅根据形态学标准仅对120 kVe图像进行全局诊断，然后对所有重建图像进行全局诊断。

结果

DECT和120 kVe图像对痛风的总体诊断敏感性为1.0（95％CI 0.63-1–1），DECT的特异性为0.70（95％CI 0.46-0.87），120特异性为0.80（95％CI 0.56-0.93）。 kVe图像。彩色编码的DECT图像没有检测到比单色标准CT图像更多的沉积物。

结论

使用DECT并主要依赖于彩色编码的图像来限制手腕的晶体关节病。在标准CT图像上评估形态学标准对于准确诊断至关重要。