Dual energy computed tomography: a novel technique for diagnosis of gout

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.