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Quantification of uric acid in vasculature of patients with gout using dual-energy computed tomography
Sharon Hannah Barazani1, Wei-Wei Chi2, Renata Pyzik1
1Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
Insights
Dual-energy CT can detect monosodium urate (MSU) deposits in blood vessels of gout patients. While gout patients showed higher MSU in the aorta, this difference was not significant after adjusting for age, which was positively associated with MSU deposition.
Area of Science:
- Radiology
- Cardiovascular Disease
- Rheumatology
Background:
- Gout is the most common inflammatory arthritis, linked to hyperuricemia and monosodium urate crystal deposition.
- Gout is an independent risk factor for hypertension, cardiovascular disease (CVD), and mortality.
- The mechanism linking gout to increased CVD risk is not fully understood.
Purpose of the Study:
- To evaluate dual-energy computed tomography (DECT) for identifying monosodium urate (MSU) within the vessel walls of gout patients.
- To compare MSU deposition in the vasculature between gout patients and controls.
- To elucidate the role of vascular MSU in the elevated CVD risk associated with gout.
Main Methods:
- DECT scans of the chest and abdomen were performed on 31 gout patients and 18 controls.
- A material decomposition algorithm differentiated MSU (green) and calcifications (purple) from soft tissue.
- Semi-automated software calculated the volume of MSU deposits; Mann-Whitney U test and rank regression analyzed differences.
Main Results:
- Gout patients exhibited significantly higher aortic MSU volume and deposit counts than controls (P=0.01 and P=0.008, respectively).
- These differences became insignificant after adjusting for age, gender, CVD history, and diabetes.
- A strong positive correlation was found between age and total urate volume (r=0.64).
Conclusions:
- DECT can quantify vascular urate deposits, showing potential differences between gout patients and controls.
- The association between gout and vascular urate deposition diminished after age adjustment.
- This study supports the presence of vascular MSU deposition and its positive correlation with aging, though definitive proof of MSU requires further validation.
Background:
Gout, caused by hyperuricemia and subsequent deposition of aggregated monosodium urate crystals (MSU) in the joints or extra-articular regions, is the most common inflammatory arthritis. There is increasing evidence that gout is an independent risk factor for hypertension, cardiovascular disease progression and mortality.
Aim:
To evaluate if dual energy computed tomography (DECT) could identify MSU within vessel walls of gout patients, and if MSU deposits within the vasculature differed between patients with gout and controls. This study may help elucidate why individuals with gout have increased risk for cardiovascular disease.
Methods:
31 gout patients and 18 controls underwent DECT scans of the chest and abdomen. A material decomposition algorithm was used to distinguish regions of MSU (coded green), and calcifications (coded purple) from soft tissue (uncoded). Volume of green regions was calculated using a semi-automated volume assessment program. Between-group differences were analyzed using Mann-Whitney U exact test and nonparametric rank regression.
Results:
Gout patients had significantly higher volume of MSU within the aorta compared to controls [Median (Min-Max) of 43.9 (0-1113.5) vs 2.9 (0-219.4), P = 0.01]. Number of deposits was higher in gout patients compared to controls [Median (Min-Max) of 20 (0-739) vs 1.5 (0-104), P = 0.008]. However, the difference was insignificant after adjustment for age, gender, history of cardiovascular disease and diabetes. Increased age was positively associated with total urate volume (r s = 0.64; 95% confidence interval: 0.43-0.78).
Conclusion:
This pilot study showed that DECT can quantify vascular urate deposits with variation across groups, with gout patients possibly having higher deposition. This relationship disappeared when adjusted for age, and there was a positive relationship between age and MSU deposition. While this study does not prove that green coded regions are truly MSU deposition, it corroborates recent studies that show the presence of vascular deposition.
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