1
|
Stewart S, Su I, Gamble GD, Dalbeth N. Diagnostic value of different imaging features for patients with suspected gout: A network meta-analysis. Semin Arthritis Rheum 2021; 51:1251-1257. [PMID: 34763198 DOI: 10.1016/j.semarthrit.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Microscopic identification of monosodium urate (MSU) crystals is the gold standard for gout diagnosis. However, joint aspiration is not always practical, and imaging is increasingly used in clinical practice. This study aimed to assess the diagnostic accuracy of imaging features for gout compared with microscopy, using network meta-analysis methodology. METHODS MEDLINE, EMBASE, PubMed and Cochrane databases were searched for studies reporting on the use of imaging modalities to diagnose gout in patients with an unclear diagnosis or suspected gout, which was later confirmed by microscopy. A combination of direct and indirect comparisons were performed by network meta-analysis to evaluate the combined odds ratios for sensitivity, specificity, and accuracy. To assist interpretation, the surface under the cumulative ranking curve (SUCRA) scores were calculated to provide a ranking of the imaging features. RESULTS Fifteen eligible studies were included. Compared to the gold standard microscopic identification of MSU crystals, dual energy computed tomography (DECT) MSU crystal deposition and ultrasound double contour had greater sensitivity than ultrasound tophus. DECT, ultrasound double contour sign and ultrasound tophus all had greater specificity than ultrasound aggregates. The SUCRA scores ranked DECT as highest for overall accuracy, followed by ultrasound double contour, aggregates, and tophus, while ultrasound snowstorm was ranked the lowest. However, there were no significant differences in the odds ratios for overall accuracy between these imaging features. CONCLUSION DECT and ultrasound are both useful modalities for the detection of imaging features of MSU crystal deposition, and have a similar overall diagnostic accuracy for gout diagnoses.
Collapse
Affiliation(s)
- Sarah Stewart
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Isabel Su
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Gregory D Gamble
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| |
Collapse
|
2
|
Lombard C, Gillet R, Rauch A, Germain E, Dodin G, Blum A, Teixeira PG. Hallux sesamoid complex imaging: a practical diagnostic approach. Skeletal Radiol 2020; 49:1889-1901. [PMID: 32583133 DOI: 10.1007/s00256-020-03507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 02/02/2023]
Abstract
A wide variety of pathologies can affect the hallux sesamoid complex of the foot, including traumatic, micro traumatic, degenerative, inflammatory, vascular, infectious, and neoplastic conditions. Symptoms are quite nonspecific, mainly related to pain in the plantar surface of the first metatarsal head. In this context, imaging is important for the etiologic diagnosis of hallux sesamoid complex pathology with implications in patient management. The hallux sesamoid complex has a complex anatomy, and pathologic processes of this region are poorly known of radiologists. Besides, some entities such as "sesamoiditis" remain poorly defined in the literature. Schematically, conditions affecting sesamoids will be divided into two major groups: intrinsic anomalies (sesamoid bone being the center of the pathologic process) and extrinsic anomalies (diseases secondarily involving sesamoid bones). Thus, in this article, after a review of anatomical key points and pathologies affecting the hallux sesamoid complex, a practical multimodality approach for the diagnosis of hallux sesamoid pathologies will be proposed.
Collapse
Affiliation(s)
- Charles Lombard
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France.
| | - Romain Gillet
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Aymeric Rauch
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Edouard Germain
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Gauthier Dodin
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Alain Blum
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Pedro Gondim Teixeira
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| |
Collapse
|
3
|
Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise. Rheumatol Int 2018; 39:707-713. [PMID: 30539275 DOI: 10.1007/s00296-018-4220-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/01/2018] [Indexed: 12/19/2022]
Abstract
The aim of this study was to evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. Images from patients with gout (static images and videos) were collected. As an initial step, we carried out a image reading exercise within the experts of the Pan-American League of Associations for Rheumatology (PANLAR) US Study Group (n = 16). The following step consisted in a web-based exercise with the participation of larger number of sonographers (n = 63) from different centers. Images were rated evaluating the presence/absence of any US elementary lesion. Inter- and intra-reader reliabilities were analyzed using kappa coefficients. Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience. The reliability of the new OMERACT US definitions for elementary lesions in gout ranged from moderate to excellent, depending on the type of lesion.
Collapse
|
4
|
Wang Y, Deng X, Xu Y, Ji L, Zhang Z. Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography: A cross-sectional study in patients with clinically diagnosed gout. Medicine (Baltimore) 2018; 97:e12834. [PMID: 30334984 PMCID: PMC6211858 DOI: 10.1097/md.0000000000012834] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aim of our study was to compare the performance of ultrasonography (US) and dual-energy computed tomography (DECT) in detecting the crystal deposition at lower extremity joints in patients with gout. The correlation of imaging findings with microscopic findings was further assessed whenever aspiration is available.We recruited consecutive patients who were presented with arthritis of lower extremity from January 2012 to December 2014. All the patients underwent DECT and US scan of bilateral knees, ankles, and feet. Synovial fluid was obtained by aspiration from an acute inflammatory joint if possible.Finally, 60 patients fulfilling the 1977 gout classification criteria were included in our study. We found that US can detect significantly more patients with crystal deposition than DECT (81.7% vs 56.7%, by US and DECT, respectively, P < .001). The frequency of urate crystal deposition detected by US at MTP1, knee, and ankle joints regions was 56.7%, 63.3%, and 51.7%, respectively. The percentage of positivity of double contour sign on US was 33.3%, 48.3%, and 41.7% at the joints mentioned above, respectively. There was a good correlation between ultrasound and synovial fluid analysis in detecting crystal deposition (κ = 0.87, P = .001), while the agreement between DECT and synovial fluid analysis was just fair (κ = 0.28, P = .02).The sensitivity of US in detecting urate crystal deposition in lower extremity joints was higher than DECT. The superiority was more obvious in knee and MTP1 joints. US should be considered as the first choice of image examinations when diagnosing gout.
Collapse
Affiliation(s)
- Yu Wang
- Department of Rheumatology and Clinical Immunology
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology
| | - Yufeng Xu
- Department of Radiology, Peking University First Hospital, Beijing, PR China
| | - Lanlan Ji
- Department of Rheumatology and Clinical Immunology
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology
| |
Collapse
|
5
|
Gutierrez M, Rodriguez S, Soto-Fajardo C, Santos-Moreno P, Sandoval H, Bertolazzi C, Pineda C. Ultrasound of sacroiliac joints in spondyloarthritis: a systematic review. Rheumatol Int 2018; 38:1791-1805. [PMID: 30099591 DOI: 10.1007/s00296-018-4126-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/05/2018] [Indexed: 12/25/2022]
Abstract
Ultrasound (US) is an accessible imaging technique with a possible role to diagnose active sacroiliitis, so this technique is projected as a promising diagnostic tool for the diagnosis of SpA. We analyse the available evidence about the use of US as a diagnostic tool in sacroiliitis in patients with SpA, by a systemic review of the literature fulfilling OMERACT criteria. A systematic literature search for original articles was carried out using four databases (Medline, Embase, Scopus and Web of Science). Data from studies were included only if participants had SpA and a US examination of sacroiliac joint (SIJ) was performed. The methodological quality of the studies was assessed using QUADAS-2 tool. Thirteen studies were included. All studies were observational, prospective and cross-sectional. In most articles (76.9%), the main US finding compatible with sacroiliitis evaluated was the presence of vascularisation (Doppler signals) with measurements of the resistive index (RI). The sensitivity and specificity analysis were performed in seven studies (58.8%) and were good, with a median of 90 and 89.2%, respectively. The studies showed a positive to moderate a strong correlation between the US and the gold standard but this was optimal only in four studies. In general, the agreement was good in all studies (≥ 0.80). The methods of evaluation of sacroiliitis vary between the studies included. To date, there is not enough evidence to support the use of ultrasound as a diagnostic method for sacroiliitis but it has potential to identify structural lesions at SIJ's level.
Collapse
Affiliation(s)
- Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Colonia Arenal de Guadalupe, CP 143898, Mexico City, Mexico.,Rheumatology Center of Excellence, Mexico City, Mexico
| | - Sheila Rodriguez
- Hospital de Alta Complejidad Virgen de la Puerta, Trujillo, Peru
| | - Carina Soto-Fajardo
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Colonia Arenal de Guadalupe, CP 143898, Mexico City, Mexico
| | | | - Hugo Sandoval
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Colonia Arenal de Guadalupe, CP 143898, Mexico City, Mexico
| | - Chiara Bertolazzi
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Colonia Arenal de Guadalupe, CP 143898, Mexico City, Mexico
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Colonia Arenal de Guadalupe, CP 143898, Mexico City, Mexico.
| |
Collapse
|
6
|
Acute Gouty Knee Arthritis: Ultrasound Findings Compared With Dual-Energy CT Findings. AJR Am J Roentgenol 2018; 210:1323-1329. [PMID: 29702022 DOI: 10.2214/ajr.17.19199] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare findings of ultrasound (US) with dual-energy CT (DECT) findings in patients presenting with suspected gouty knee arthritis. SUBJECTS AND METHODS This prospective study included 65 patients (52 men and 13 women; median age, 61.7 years [range, 38-87 years]) with an initial clinical diagnosis of acute gouty knee arthritis who underwent DECT performed using a 128-MDCT scanner and US performed using a 5-18-MHz transducer. Both intra- and extraarticular findings obtained using each modality were tabulated. RESULTS DECT identified gout as the final diagnosis for 52 of 65 patients (80.0%). An alternative diagnosis was confirmed for the remaining 13 patients. US detected gout in 31 of 52 patients (sensitivity, 59.6%) and produced findings negative for gout in seven of 13 patients (specificity, 53.8%). The double contour sign on US was positive for gout in 23 of 52 patients (44.2%) and negative in 12 of 13 patients (92.3%). Extraarticular urate deposition was identified by DECT in 44 of 52 patients, compared with identification by US in 11 of 52 patients (p < 0.001). CONCLUSION The sensitivity of US for the diagnosis of gouty knee arthritis is limited, particularly with respect to extraarticular urate deposition. The double contour sign is the single most valuable sign for the assessment of gouty knee arthritis by US.
Collapse
|
7
|
Klauser AS, Halpern EJ, Strobl S, Abd Ellah MMH, Gruber J, Bellmann-Weiler R, Auer T, Feuchtner G, Jaschke W. Gout of hand and wrist: the value of US as compared with DECT. Eur Radiol 2018; 28:4174-4181. [PMID: 29679210 PMCID: PMC6132720 DOI: 10.1007/s00330-018-5363-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 12/27/2022]
Abstract
Objectives The purpose of this study was to compare findings of ultrasound (US) with dual-energy CT (DECT) in patients presenting with suspected gouty hand and wrist arthritis. Methods This prospective study included 180 patients (136 men and 44 women, age range, 31– 94 years; mean age, 65.9 years) with an initial clinical diagnosis of acute gouty arthritis who underwent DECT and US examination. Intra- and extra-articular findings of each modality were tabulated and calculated with DECT as gold standard. Results The final diagnosis of gout was positive in 97/180 patients (53.9%) by DECT, an alternative diagnosis confirmed in 83 patients. US showed a sensitivity of 70.1% (extra-articular: 42.5%, p < 0.0001; intra-articular: 80.3%, p = 0.14) and specificity of 51%. The double contour sign (DCS) was present in 58/61 patients with a positive US study for intra-articular gout (95.1%). Conclusions Sensitivity of US for diagnosis of gouty arthritis in hand and wrist is limited, particularly with respect to extra-articular urate deposition. The DCS is the most sensitive sign for the assessment of gouty hand and wrist arthritis by US. Key points • Sensitivity of US for diagnosis of gouty arthritis in hand and wrist is limited, particularly with respect to extra-articular gouty deposits. • The double contour sign is the most sensitive finding for the assessment of gouty hand and wrist arthritis by US. • Although the sensitivity of US for diagnosis of gouty hand and wrist arthritis is limited, it can be used as a first-line imaging modality in the presence of the DCS.
Collapse
Affiliation(s)
- Andrea S Klauser
- Radiology Department, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ethan J Halpern
- Department of Radiology and Urology, Jefferson Prostate Diagnostic and Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 1112, Philadelphia, PA, 19107, USA
| | - Sylvia Strobl
- Radiology Department, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Mohamed M H Abd Ellah
- Radiology Department, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,Diagnostic Radiology Department, South Egypt Cancer Institute, Assiut University, Assiut, 71515, Egypt
| | - Johann Gruber
- Department of Internal Medicine II, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Thomas Auer
- Radiology Department, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gudrun Feuchtner
- Radiology Department, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Werner Jaschke
- Radiology Department, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| |
Collapse
|
8
|
Ogdie A, Taylor WJ, Neogi T, Fransen J, Jansen TL, Schumacher HR, Louthrenoo W, Vazquez-Mellado J, Eliseev M, McCarthy G, Stamp LK, Perez-Ruiz F, Sivera F, Ea HK, Gerritsen M, Cagnotto G, Cavagna L, Lin C, Chou YY, Tausche AK, Lima Gomes Ochtrop M, Janssen M, Chen JH, Slot O, Lazovskis J, White D, Cimmino MA, Uhlig T, Dalbeth N. Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study: Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard. Arthritis Rheumatol 2017; 69:429-438. [PMID: 27748084 DOI: 10.1002/art.39959] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the performance of ultrasound (US) for the diagnosis of gout using the presence of monosodium urate monohydrate (MSU) crystals as the gold standard. METHODS We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multicenter observational cross-sectional study of consecutive subjects with at least 1 swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with confirmed MSU crystals. Rheumatologists or radiologists who were blinded with regard to the results of the MSU crystal analysis performed US on 1 or more clinically affected joints. US findings of interest were double contour sign, tophus, and snowstorm appearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive US results among subjects with gout. RESULTS US was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV, and NPV for the presence of any 1 of the features were 76.9%, 84.3%, 83.3%, and 78.2%, respectively. Sensitivity was higher among subjects with a disease duration of ≥2 years and among subjects with subcutaneous nodules on examination (suspected tophus). Associations with a positive US finding included suspected clinical tophus (odds ratio [OR] 4.77 [95% confidence interval (95% CI) 2.23-10.21]), any abnormality on plain radiography (OR 4.68 [95% CI 2.68-8.17]), and serum urate level (OR 1.31 [95% CI 1.06-1.62]). CONCLUSION US features of MSU crystal deposition had high specificity and high PPV but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi.
Collapse
Affiliation(s)
| | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | - Jaap Fransen
- VieCuri Medical Centre, Venlo, The Netherlands, and Scientific IQ HealthCare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim L Jansen
- VieCuri Medical Centre, Venlo, The Netherlands, and Scientific IQ HealthCare, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Maxim Eliseev
- Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia
| | - Geraldine McCarthy
- University College Dublin and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lisa K Stamp
- University of Otago Christchurch, Christchurch, New Zealand
| | - Fernando Perez-Ruiz
- Hospital Universitario Cruces, BioCruces Health Research Institute, and Basque Country University, Barakaldo, Spain
| | | | - Hang-Korng Ea
- Université Paris Diderot, INSERM UMR 1132 and Service de Rhumatologie, Hôpital Lariboisière, AP-HP, Paris, France
| | | | - Giovanni Cagnotto
- University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy, and Skane University Hospital Malmö/Lund, Lund, Sweden
| | - Lorenzo Cavagna
- University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Chingtsai Lin
- Taichung Veterans' General Hospital, Taichung, Taiwan, Republic of China
| | - Yin-Yi Chou
- Taichung Veterans' General Hospital, Taichung, Taiwan, Republic of China
| | | | | | | | - Jiunn-Horng Chen
- China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ole Slot
- Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | - Douglas White
- Waikato District Health Board and Waikato Clinical School, Hamilton, New Zealand
| | | | | | | |
Collapse
|
9
|
Taljanovic MS, Melville DM, Gimber LH, Scalcione LR, Miller MD, Kwoh CK, Klauser AS. High-Resolution US of Rheumatologic Diseases. Radiographics 2016; 35:2026-48. [PMID: 26562235 DOI: 10.1148/rg.2015140250] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For the past 15 years, high-resolution ultrasonography (US) is being routinely and increasingly used for initial evaluation and treatment follow-up of rheumatologic diseases. This imaging technique is performed by using high-frequency linear transducers and has proved to be a powerful diagnostic tool in evaluation of articular erosions, simple and complex joint and bursal effusions, tendon sheath effusions, and synovitis, with results comparable to those of magnetic resonance imaging, excluding detection of bone marrow edema. Crystal deposition diseases including gouty arthropathy and calcium pyrophosphate deposition disease (CPPD) have characteristic appearances at US, enabling differentiation between these two diseases and from inflammatory arthropathies. Enthesopathy, which frequently accompanies psoriatic and reactive arthritis, also has a characteristic appearance at high-resolution US, distinguishing these two entities from other inflammatory and metabolic arthropathies. The presence of Doppler signal in examined joints, bursae, and tendon sheaths indicates active synovitis. Microbubble echo contrast agents augment detection of tissue vascularity and may act in the future as a drug delivery vehicle. Frequently, joint, tendon sheath, and bursal fluid aspirations and therapeutic injections are performed under US guidance. The authors describe the high-resolution US technique including gray-scale, color or power Doppler, and contrast agent-enhanced US that is used in evaluation of rheumatologic diseases of the wrist and hand and the ankle and foot in their routine clinical practice. This article demonstrates imaging findings of normal joints, rheumatoid arthritis, gouty arthritis, CPPD, psoriatic and reactive arthritis, and osteoarthritis.
Collapse
Affiliation(s)
- Mihra S Taljanovic
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - David M Melville
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Lana H Gimber
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Luke R Scalcione
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Margaret D Miller
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - C Kent Kwoh
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Andrea S Klauser
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| |
Collapse
|
10
|
Omoumi P, Zufferey P, Malghem J, So A. Imaging in Gout and Other Crystal-Related Arthropathies. Rheum Dis Clin North Am 2016; 42:621-644. [PMID: 27742018 DOI: 10.1016/j.rdc.2016.07.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In this article, the authors consider the manifestations of intraarticular and periarticular crystal deposits. Most cases of crystal deposits are asymptomatic and represent incidental findings at imaging. In symptomatic arthropathies, imaging can play an important role in the diagnosis and assessment of disease progression and the extent of crystal deposits. Conventional radiography is the most common imaging modality. But ultrasound, conventional computerized tomography (CT), dual-energy CT, and MRI play an increasing role. The authors review typical radiographic features of crystal-induced arthropathies and findings that help to differentiate them. The authors also emphasize the increasing role of complementary imaging techniques.
Collapse
Affiliation(s)
- Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland.
| | - Pascal Zufferey
- Department of Rheumatology, Lausanne University Hospital, Av Pierre Decker 5, Lausanne 1011, Switzerland
| | - Jacques Malghem
- Department of Radiology, Saint Luc University Hospital, UC Louvain, Av Hippocrate 10, Brussels 1200, Belgium
| | - Alexander So
- Department of Rheumatology, Lausanne University Hospital, Av Pierre Decker 5, Lausanne 1011, Switzerland
| |
Collapse
|
11
|
Rheinboldt M, Scher C. Musculoskeletal ultrasonography in the diagnosis of acute crystalline synovitis. Emerg Radiol 2016; 23:623-632. [DOI: 10.1007/s10140-016-1419-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/28/2016] [Indexed: 12/19/2022]
|
12
|
Ventura-Ríos L, Sánchez-Bringas G, Pineda C, Hernández-Díaz C, Reginato A, Alva M, Audisio M, Bertoli A, Cazenave T, Gutiérrez M, Mora C, Py G, Sedano O, Solano C, de Miguel E. Tendon involvement in patients with gout: an ultrasound study of prevalence. Clin Rheumatol 2016; 35:2039-2044. [DOI: 10.1007/s10067-016-3309-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/06/2016] [Accepted: 05/11/2016] [Indexed: 12/27/2022]
|
13
|
Abstract
The prevalence of gout in the US population is steadily increasing. Genome-wide research has found several variants of DNA sequences that predispose patients to irregular uric acid metabolism. Comorbidities linked to gout include obesity and cardiovascular disease. Though the formal diagnosis is made with arthrocentesis and subsequent analysis, CT and ultrasound findings supplement the diagnosis and monitor disease management. Newer immunologic agents are available for patients whose disease is refractory to standard therapy.
Collapse
|
14
|
Diekhoff T, Ziegeler K, Feist E, Kiefer T, Mews J, Hamm B, Hermann KGA. First experience with single-source dual-energy computed tomography in six patients with acute arthralgia: a feasibility experiment using joint aspiration as a reference. Skeletal Radiol 2015; 44:1573-7. [PMID: 26142537 DOI: 10.1007/s00256-015-2204-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/29/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Dual-energy computed tomography (DECT) is an emerging imaging technique for examining patients with suspected gout. Single-source dual-energy CT (S-DECT) is a new way of obtaining DECT information on conventional CT scanners rather than using special dual-source CT systems. METHODS We tested the feasibility of S-DECT (320-row CT; Aquilion ONE, Toshiba Medical Systems, Otawara, Japan) in 6 patients (5 men, 1 woman; mean age 61.3, range 48 to 69 years) with acute arthralgia and suspected gout, and compared the S-DECT findings with the results of joint aspiration. RESULTS Three patients had a diagnosis of gouty arthritis with negatively birefringent crystals in synovial fluid, in addition to gouty tophi in S-DECT. Three patients had no detectable crystals by polarization microscopy and no tophi on DECT. Their final diagnoses were rheumatoid arthritis, activated osteoarthritis, and septic arthritis in one case each. CONCLUSION This initial experience suggests that S-DECT might be a valuable alternative to dual-source CT. Hence, more patients may benefit from its additional diagnostic abilities in the future.
Collapse
Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Katharina Ziegeler
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Tobias Kiefer
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jürgen Mews
- Toshiba Medical Systems Europe, BV, Zilverstraat 1, 2701 RP, Zoetermeer, Netherlands
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kay-Geert A Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
15
|
Gutierrez M, Schmidt WA, Thiele RG, Keen HI, Kaeley GS, Naredo E, Iagnocco A, Bruyn GA, Balint PV, Filippucci E, Mandl P, Kane D, Pineda C, Delle Sedie A, Hammer HB, Christensen R, D'Agostino MA, Terslev L. International Consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise. Rheumatology (Oxford) 2015; 54:1797-805. [PMID: 25972391 DOI: 10.1093/rheumatology/kev112] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To produce consensus-based definitions of the US elementary lesions in gout and to test their reliability in a web-based exercise. METHODS The process consisted of two steps. In the first step a written Delphi questionnaire was developed from a systematic literature review and expert international consensus. This collated information resulted in four statements defining US elementary lesions: double contour (DC), tophus, aggregates and erosion. The Delphi questionnaire was sent to 35 rheumatology experts in US, asking them to rate their level of agreement or disagreement with each statement. The second step tested the reliability by a web-exercise. US images of both normal and gouty elementary lesions were collected by the participants. A facilitator then constructed an electronic database of 110 images. The database was sent to the participants, who evaluated the presence/absence of US elementary lesions. A group of 20 images was displayed twice to evaluate intra-reader reliability. RESULTS A total of 32 participants responded to the questionnaires. Good agreement (>80%) was obtained for US definitions on DC, tophus, aggregates and erosion in the Delphi exercise after three rounds. The reliability on images showed inter-reader κ values for DC, tophus, aggregates, erosion findings of 0.98, 0.71, 0.54 and 0.85, respectively. The mean intra-reader κ values were also acceptable: 0.93, 0.78, 0.65 and 0.78, respectively. CONCLUSION This, the first consensus-based US definition of elementary lesions in gout, demonstrated good reliability overall. It constitutes an essential step in developing a core outcome measurement that permits a higher degree of homogeneity and comparability between multicentre studies.
Collapse
Affiliation(s)
- Marwin Gutierrez
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy,
| | - Wolfgang A Schmidt
- Rheumatology Department, Immanuel Krankenhaus, Medical Centre for Rheumatology, Berlin, Germany
| | - Ralf G Thiele
- Department of Medicine, Allergy/Immunology and Rheumatology Division, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Helen I Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | - Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Esperanza Naredo
- Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Annamaria Iagnocco
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome
| | - George A Bruyn
- Rheumatology Department, MC Groep Hospitals, Lelystad, Netherlands
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Emilio Filippucci
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - David Kane
- Rheumatology Department, Trinity College, Dublin, Ireland
| | - Carlos Pineda
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | | | | | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Maria Antonietta D'Agostino
- INSERM U1173, Rheumatology Department, Laboratoire d'excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France and
| | - Lene Terslev
- Rheumatology Department, Center for Rheumatology and Spine diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | | |
Collapse
|
16
|
Ogdie A, Taylor WJ, Weatherall M, Fransen J, Jansen TL, Neogi T, Schumacher HR, Dalbeth N. Imaging modalities for the classification of gout: systematic literature review and meta-analysis. Ann Rheum Dis 2014; 74:1868-74. [PMID: 24915980 DOI: 10.1136/annrheumdis-2014-205431] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although there has been major progress in gout imaging, no gout classification criteria currently include advanced imaging techniques. OBJECTIVE To examine the usefulness of imaging modalities in the classification of gout when compared to monosodium urate (MSU) crystal confirmation as the gold standard, in order to inform development of new gout classification criteria. METHODS We systematically reviewed the published literature concerning the diagnostic performance of plain film radiography, MRI, ultrasound (US), conventional CT and dual energy CT (DECT). Only studies with MSU crystal confirmation as the gold standard were included. When more than one study examined the same imaging feature, the data were pooled and summary test characteristics were calculated. RESULTS 11 studies (9 manuscripts and 2 meeting abstracts) satisfied the inclusion criteria. All were set in secondary care, with mean gout disease duration of at least 7 years. Three features were examined in more than one study: the double contour sign (DCS) on US, tophus on US, and MSU crystal deposition on DECT. The pooled (95% CI) sensitivity and specificity of US DCS were 0.83 (0.72 to 0.91) and 0.76 (0.68 to 0.83), respectively; of US tophus, were 0.65 (0.34 to 0.87) and 0.80 (0.38 to 0.96), respectively; and of DECT, were 0.87 (0.79 to 0.93) and 0.84 (0.75 to 0.90), respectively. CONCLUSIONS US and DECT show promise for gout classification but the few studies to date have mostly been in patients with longstanding, established disease. The contribution of imaging over clinical features for gout classification criteria requires further examination.
Collapse
Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jaap Fransen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim L Jansen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tuhina Neogi
- Sections of Epidemiology and Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - H Ralph Schumacher
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
17
|
[Diagnosis and management of gout in Austria. Survey of current practice considering the EULAR recommendations]. Z Rheumatol 2014; 73:836-42. [PMID: 24763908 DOI: 10.1007/s00393-014-1371-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Gout shows an increasing incidence and has become a major health problem in the Western world. Despite effective treatment options, neither diagnosis nor therapeutic efforts can be regarded sufficient to date. It was of interest to investigate current handling of gout among Austrian rheumatologists. MATERIAL AND METHODS In 2012, a survey of Austrian rheumatologists concerning diagnosis and management of hyperuricemia and gout was performed. With the consent of the Austrian Society of Rheumatology, 574 society members (343 via electronic mail, 23 via mail) were sent a questionnaire consisting of 17 questions. This is the first survey assessing the management of gout among Austrian rheumatologists. RESULTS The overall response rate was 22.1 %. Of all the contacted members (email and mail), 19.9 % answered the questionnaire electronically and only 5.6 % by mail. The adherence to the EULAR recommendations for gout ranged between 69 and 95 % (median 84 %). CONCLUSION Among Austrian rheumatologists, the knowledge about gout, its diagnostic and imaging procedures, management and therapeutic goals is good and mainly in line with current international recommendations. To improve the management of patients with gout and hyperuricemia, a more frequent referral to rheumatologists could be beneficial.
Collapse
|
18
|
Huppertz A, Hermann KGA, Diekhoff T, Wagner M, Hamm B, Schmidt WA. Systemic staging for urate crystal deposits with dual-energy CT and ultrasound in patients with suspected gout. Rheumatol Int 2014; 34:763-71. [PMID: 24619560 DOI: 10.1007/s00296-014-2979-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/28/2014] [Indexed: 12/22/2022]
Abstract
Objective of the study is to compare the diagnostic accuracy for detecting monosodium urate crystal deposits between dual-energy CT (DECT) and ultrasound (US). Sixty consecutive patients (49 men, mean age 62 years) with clinically suspected gout were included in this case-control study. DECT and US of feet, knees, hands and elbows were performed in all patients. Polarisation microscopy of synovial fluid or a score incorporating serum uric acid level, first MTP joint involvement, gender, previous patient-reported arthritis attack, cardiovascular diseases, joint redness and onset within 1 day was used as standard of reference. Standard of reference classified 39 patients as gout positive. Sixteen patients had gout and a concomitant rheumatic disease. Sensitivities for diagnosis of gout disease were 84.6 % (33/39) for DECT and 100 % (39/39) for US. Specificities were 85.7 % (18/21) for DECT and 76.2 % (16/21) for US. Positive and negative predictive values were 91.7 % (33/36) and 75.0 % (18/24) for DECT, 88.6 % (39/44) and 100 % (16/16) for US, respectively. Urate crystals were detected most frequently in MTP1 joints (DECT 20/78, US 58/78), any other toe joints (DECT 25/78, US 62/78) and knees (DECT 41/78, US 31/78). The volumetry of DECT computed a mean urate crystal deposit load of 2.1 cm(3) (SD 9.6 cm(3)). A mean effective dose of ≤0.5 mSv was estimated. DECT is more specific for the diagnosis of gout than US. However, it fails to detect small urate crystal deposits. It might be particularly useful for patients with ambivalent findings, concomitant rheumatic diseases and with non-conclusive joint aspiration.
Collapse
Affiliation(s)
- Alexander Huppertz
- Department of Radiology, Charité - University Hospitals, Charitéplatz 1, 10117, Berlin, Germany,
| | | | | | | | | | | |
Collapse
|