Dual-Energy Computed Tomography Has Additional Prognostic Value Over Clinical Measures in Gout Including Tophi: A Systematic Literature Review

Objective. This systematic literature review determined whether there is clinical utility for dual-energy computed tomography (DECT) to inform on prognosis for patients with gout. With DECT, individualized treatment plans could be developed based on the patient's unique urate burden, with DECT being used as a clinical outcome measure in gout management. Methods. To evaluate DECT as a reliable, valid, and sensitive prognostic instrument, a librarian- assisted search was undertaken in PubMed and Embase for articles on gout and DECT informing on reliability; content, construct, and criterion validity; sensitivity to change; and minimum clinically important changes. Results. This systematic literature review showed that DECT has high intra- and interrater reliability. Tophus burden correlates with functional loss to show content validity. DECT volume is positively correlated with death, cardiovascular risk factors, and the risk for future gout flares. DECT has excellent sensitivity to change with effective urate-lowering therapies. Conclusion. DECT is a promising prognostic tool based on its high reliability, sensitivity to change, and emerging validity. Additional large, well-designed, prospective cohort studies are needed to fully evaluate its prognostic utility. This systematic review suggests that DECT very likely has additional prognostic information beyond clinical tophi assessment alone.