Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study.
Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study.
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双能CT诊断痛风的CT：精确性和诊断产量研究。
DOI：
10.1136/annrheumdis-2013-205095
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发表时间：
2015-06
影响因子：
27.4
通讯作者：
McCollough CH
中科院分区：
文献类型：
--
作者：
Bongartz T;Glazebrook KN;Kavros SJ;Murthy NS;Merry SP;Franz WB 3rd;Michet CJ;Veetil BM;Davis JM 3rd;Mason TG 2nd;Warrington KJ;Ytterberg SR;Matteson EL;Crowson CS;Leng S;McCollough CH
评估双能量CT（DECT）诊断痛风的准确性，并探讨其是否会对临床决策产生任何影响，超出使用滑膜液偏振显微镜的既定诊断方法（诊断率）。对40名活动性痛风患者和41名其他类型关节疾病患者进行的诊断性单中心研究。DECT诊断痛风的敏感性和特异性根据联合参考标准（滑液的极化和电子显微镜检查）计算。为了探索DECT扫描的诊断率，第三个队列由具有炎症性关节炎和痛风风险因素的患者组成，这些患者的滑液偏振显微镜结果为阴性。在这些患者中，评估了DECT结果提示痛风诊断的受试者比例。DECT诊断痛风的敏感性和特异性分别为0.90（95%CI 0.76 ~ 0.97）和0.83（95%CI 0.68 ~ 0.93）。所有假阴性患者均在急性、近期发作的痛风患者中观察到。所有假阳性患者均为晚期膝关节骨关节炎。诊断率队列中的DECT显示30例患者中有14例（46.7%）存在尿酸沉积证据。DECT为痛风患者的尿酸盐（MSU）沉积检测提供了良好的诊断准确性。然而，在新近发病的患者中敏感性较低。当怀疑痛风时，DECT对临床决策有显著影响，但滑液的偏振显微镜检查未能证明MSU晶体的存在。
To assess the accuracy of dual-energy CT (DECT) for diagnosing gout, and to explore whether it can have any impact on clinical decision making beyond the established diagnostic approach using polarising microscopy of synovial fluid (diagnostic yield). Diagnostic single-centre study of 40 patients with active gout, and 41 individuals with other types of joint disease. Sensitivity and specificity of DECT for diagnosing gout was calculated against a combined reference standard (polarising and electron microscopy of synovial fluid). To explore the diagnostic yield of DECT scanning, a third cohort was assembled consisting of patients with inflammatory arthritis and risk factors for gout who had negative synovial fluid polarising microscopy results. Among these patients, the proportion of subjects with DECT findings indicating a diagnosis of gout was assessed. The sensitivity and specificity of DECT for diagnosing gout was 0.90 (95% CI 0.76 to 0.97) and 0.83 (95% CI 0.68 to 0.93), respectively. All false negative patients were observed among patients with acute, recent-onset gout. All false positive patients had advanced knee osteoarthritis. DECT in the diagnostic yield cohort revealed evidence of uric acid deposition in 14 out of 30 patients (46.7%). DECT provides good diagnostic accuracy for detection of monosodium urate (MSU) deposits in patients with gout. However, sensitivity is lower in patients with recent-onset disease. DECT has a significant impact on clinical decision making when gout is suspected, but polarising microscopy of synovial fluid fails to demonstrate the presence of MSU crystals.
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影响因子：
27.4
作者：
Choi, H. K.;Al-Arfaj, A. M.;Nicolaou, S.
通讯作者：
Nicolaou, S.
影响因子：
27.4
作者：
Swan, A;Amer, H;Dieppe, P
通讯作者：
Dieppe, P
影响因子：
27.4
作者：
Zhang, W.;Doherty, M.;Zimmermann-Gorska, I.
通讯作者：
Zimmermann-Gorska, I.
影响因子：
4.8
作者：
Primak, Andrew N.;Fletcher, Joel G.;McCollough, Cynthia H.
通讯作者：
McCollough, Cynthia H.
影响因子：
5.5
作者：
Desai, Madhura A.;Peterson, Jeffrey J.;Kransdorf, Mark J.
通讯作者：
Kransdorf, Mark J.