Dual-energy computed tomography for gout diagnosis and management

The central feature of gout is deposition of monosodium urate crystals. Dual-energy computed tomography (DECT) is a recently developed advanced imaging method that enables visualisation of urate deposits by analysis of the chemical composition of the scanned materials. This review summarises recent research describing the use of DECT in gout management. This technology may assist in both diagnosis and monitoring of the disease. Studies of patients with established disease indicate diagnostic accuracy for gout is high. Excellent inter-reader agreement has been reported for detection of urate deposits by use of DECT. Automated volume assessment software also enables rapid and reproducible measurement of urate deposits within tophi, suggesting that this modality may be useful for monitoring the disease. Although several case reports indicate DECT can be used to reveal reduction in the size of urate deposits, the sensitivity to change in response to urate-lowering therapy has not yet been systematically reported. DECT images reveal variable urate deposition within tophi of the same physical size. The ability to visualise urate deposits in tissue may provide new insights into the pathology and mechanisms of gout.