Dual-Energy CT of Spinal Tophaceous Gout
2020; Radiological Society of North America; Volume: 296; Issue: 2 Linguagem: Inglês
10.1148/radiol.2020200816
ISSN1527-1315
Autores Tópico(s)Pelvic and Acetabular Injuries
ResumoHomeRadiologyVol. 296, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyDual-Energy CT of Spinal Tophaceous GoutBrian Gibney , Nicolas MurrayBrian Gibney , Nicolas MurrayAuthor AffiliationsFrom the Department of Radiology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada V5Z 1L5.Address correspondence to B.G. (e-mail: [email protected]).Brian Gibney Nicolas MurrayPublished Online:May 26 2020https://doi.org/10.1148/radiol.2020200816MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractDownload as PowerPointA 67-year-old man with a history of gout arthropathy underwent dual-energy CT for atraumatic acute-on-chronic severe lumbar back pain. CT depicted erosion of the left L5-S1 facet joint by a large intermediate-attenuation mass, which encroached on the left neural foramen (Figure, part a). Automated dual-energy material labeling helped confirm these areas to represent monosodium urate deposits, therefore confirming tophaceous gout (Figure, part b). This was achieved by determination of a dual-energy index for the evaluated tissues after analyzing the differential attenuation at high- and low-energy levels. Monosodium urate has a low dual-energy index, and calcium has a high dual-energy index.Spinal gout is present in up to 29% of patients with gout, although axial gout is often asymptomatic (1). A systematic review of the diagnostic accuracy of dual-energy CT in gout found a pooled sensitivity of 88% (95% confidence interval: 84%, 90%) and a specificity of 90% (95% confidence interval: 85%, 93%) (2).(a) Sagittal mixed 120-kVp equivalent images of lumbar spine obtained with dual-energy CT demonstrate an intermediate-attenuation mass in the L5-S1 facet joint with bony erosions and narrowing of the neural foramen (arrow). (b) Dual-energy material labeling color map overlay shows monosodium urate (green) and bone (blue and pink). Note the monosodium urate crystals crowding the left neural foramen (arrow).Download as PowerPointOpen in Image Viewer (a) Sagittal mixed 120-kVp equivalent images of lumbar spine obtained with dual-energy CT demonstrate an intermediate-attenuation mass in the L5-S1 facet joint with bony erosions and narrowing of the neural foramen (arrow). (b) Dual-energy material labeling color map overlay shows monosodium urate (green) and bone (blue and pink). Note the monosodium urate crystals crowding the left neural foramen (arrow).Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: B.G. disclosed no relevant relationships. N.M. disclosed no relevant relationships.References1. de Mello FM, Helito PV, Bordalo-Rodrigues M, Fuller R, Halpern AS. Axial gout is frequently associated with the presence of current tophi, although not with spinal symptoms. Spine 2014;39(25):E1531–E1536. Crossref, Medline, Google Scholar2. Yu Z, Mao T, Xu Y, et al. Diagnostic accuracy of dual-energy CT in gout: a systematic review and meta-analysis. Skeletal Radiol 2018;47(12):1587–1593. Crossref, Medline, Google ScholarArticle HistoryReceived: Mar 2 2020Revision requested: Mar 30 2020Revision received: Mar 30 2020Accepted: Apr 15 2020Published online: May 26 2020Published in print: Aug 2020 FiguresReferencesRelatedDetailsCited ByClinical images: Gout of the spineGuojieWang2022 | Arthritis & Rheumatology, Vol. 74, No. 9Medical RadiologyTorstenDiekhoff2022The Role of Advanced Imaging in Gout ManagementShuangshuangLi, GuanhuaXu, JunyuLiang, LiyanWan, HengCao, JinLin2022 | Frontiers in Immunology, Vol. 12Advanced clinical imaging for the evaluation of stem cell based therapiesMichail E.Klontzas, George A.Kakkos, Georgios Z.Papadakis, KostasMarias, Apostolos H.Karantanas2021 | Expert Opinion on Biological Therapy, Vol. 21, No. 9Recommended Articles Differential Diagnosis of Facet Joint DisordersRadioGraphics2021Volume: 41Issue: 2pp. 543-558Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar SpineRadioGraphics2016Volume: 37Issue: 2pp. 537-561Fluoroscopy-guided versus CT-guided Lumbar Steroid Injections: Comparison of Radiation Exposure and OutcomesRadiology2019Volume: 290Issue: 3pp. 752-759Spinal Injections for Pain ManagementRadiology2016Volume: 281Issue: 3pp. 669-688Injuries to the Rigid Spine: What the Spine Surgeon Wants to KnowRadioGraphics2019Volume: 39Issue: 2pp. 449-466See More RSNA Education Exhibits Pocket Guide to Key Findings of Differential Diagnoses of Facet Joints DisordersDigital Posters2019The Cervical Spine: How To Use Its Unique Anatomical Features to Optimize Diagnosis and Treatment of the Specific Degenerative ChangesDigital Posters2020Lumbar Facet Joint Septic Arthritis: CT and MRI Findings of an Important and Commonly Missed PathologyDigital Posters2019 RSNA Case Collection Facet joint synovial cystRSNA Case Collection2020 Cervical spine goutRSNA Case Collection2022Paget's disease of the spine RSNA Case Collection2020 Vol. 296, No. 2 Metrics Altmetric Score PDF download
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