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Gout tophus detection-a comparison of dual-energy CT (DECT) and histology
Ralph Melzer1, Chantal Pauli2, Thomas Treumann3
1Clinic of Rheumatology, Luzerner Kantonsspital, 6000 Lucerne 16, Switzerland.
Objectives:
To compare dual-energy CT images (DECT) directly with gold standard histology.
Methods:
A 85-year-old woman with chronic recurrent gouty arthritis and macroscopically visible tophi was assessed with DECT-scans of her feet. When she died 7 days later, three tophi in different regions and in different tissues of her left foot were processed for histological examination.
Results:
Of the selected tophi, two were almost completely missed by the color-coding DECT sequences. The tophi remained in most of their volume below the detection threshold value of 150HU (default value).
Conclusions:
It could be demonstrated that DECT only highlights the dense tophi (corresponding of approximately 15-20vol% urate in the tophus). Less dense tophi, despite considerable size, will be missed in the color-coded images.
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