Gout Of Feet And Ankles In Different Disease Durations:The Value Of Single-source DECT Based On Gemstone Spectral Imaging Technology In Patients With Suspected Arthritis

Objective The purpose of this study was to investigate the diagnostic performance of single-source dual-energy computed tomography(DECT)based on gemstone spectral imaging technology(including Discovery CT750 HD and Revolution CT)in patients with suspected feet/ankles gouty arthritis.Methods A total of 196 patients were respectively included.Feet and ankles were evaluated in all patients by single-source DECT scan.The sensitivity,specificity,and area under the receiver operating characteristic curve(AUC)of DECT for the diagnosis of gout in the early(≤1 year),middle(1–3 years),and late(>3 years)disease durations were calculated.Besides,a new semi-quantitative DECT scoring system was assessed for the measurement of urate deposition,and the correlation between the scores and the clinical and serological data were also evaluated.Moreover,the influences of artifacts on the diagnostic performance of DECT were also determined.Results The sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR)and area under the receiver operating characteristic curve(AUC)of DECT in 196 patients were 69.18%(95% CI: 61.0-76.5%)、94.00%(95% CI:83.5-98.7%)、11.53(95% CI: 3.8-34.7)、0.33(95% CI: 0.3-0.4)and 0.816(95% CI:0.754-0.868)in the overall groups.The sensitivity,specificity,PLR,NLR and AUC of DECT for the early-stage group were 38.10%(95% CI: 18.1-61.6%)、96.43%(95%CI: 81.7-99.9%)、10.67(95% CI: 1.4-78.8)、0.64(95% CI: 0.5-0.9)and 0.673(95%CI: 0.524-0.800);The sensitivity,specificity,NLR and AUC of DECT for the middle-stage group were 62.96%(95% CI: 42.4-80.6%)、100.00%(95% CI:54.1-100.0%)、0.37(95% CI: 0.2-0.6)and 0.815(95% CI: 0.642-0.928);and the sensitivity,specificity,PLR,NLR and AUC of DECT for the late-stage group were77.55%(95% CI: 68.0-85.4%)、87.50%(95% CI: 61.7-98.4%)、6.20(95% CI:1.7-22.8)、0.26(95% CI: 0.2-0.4)and 0.825(95% CI: 0.743-0.890)late-stage,respectively.The overall diagnostic accuracies in the AUC of DECT(Discovery CT750 HD and Revolution CT)in the middle and late stages of gout were higher than that in the early stage of gout.Besides,the monosodium urate crystals were deposited on the first metatarsophalangeal joints and ankles/midfeet.Age,the presence of tophus,bone erosion,and disease duration considerably affected the total urate score.No statistical difference in the positive detection of nail artifact,skin artifact,vascular calcification,and noise artifact was found between the case and control groups.Conclusion DECT(Discovery CT750 HD and Revolution CT)showed promising diagnostic accuracy for the detection of urate crystal deposition in gout but had limited diagnostic sensitivity for short-stage gout.Longer disease duration,the presence of tophus,and bone erosion were associated with the urate crystal score system.The artifacts do not remarkably affect the diagnostic performance of DECT in gout.