Quantification of uric acid in vasculature of patients with gout using dual-energy computed tomography

• 作者: Adam Jacobi Helena Chang Renata Pyzik Sharon Hannah Barazani Tom O’Donnell Venkatesh Mani Wei-Wei Chi Yousaf Ali Zahi A Fayad
• 来源期刊: 世界放射学杂志:英文版(电子版)
• 学科: 医学
• 关键词: GOUT Tophaceous Dual-energy computed tomography HYPERURICEMIA Monosodium urate Cardiovascular disease
• 年，卷（期）: 2020,（8）
• 页码范围: 184-194
• 页数: 11页
• 分类号: R58

摘要

BACKGROUNDGout, caused by hyperuricemia and subsequent deposition of aggregatedmonosodium urate crystals (MSU) in the joints or extra-articular regions, is themost common inflammatory arthritis. There is increasing evidence that gout is anindependent risk factor for hypertension, cardiovascular disease progression andmortality.AIMTo evaluate if dual energy computed tomography (DECT) could identify MSUwithin vessel walls of gout patients, and if MSU deposits within the vasculaturediffered between patients with gout and controls. This study may help elucidatewhy individuals with gout have increased risk for cardiovascular disease.METHODS31 gout patients and 18 controls underwent DECT scans of the chest andabdomen. A material decomposition algorithm was used to distinguish regions ofMSU (coded green), and calcifications (coded purple) from soft tissue (uncoded). Volume of green regions was calculated using a semi-automated volumeassessment program. Between-group differences were analyzed using Mann-Whitney U exact test and nonparametric rank regression.RESULTSGout patients had significantly higher volume of MSU within the aorta comparedto 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 wasinsignificant after adjustment for age, gender, history of cardiovascular diseaseand diabetes. Increased age was positively associated with total urate volume (rs =0.64;95% confidence interval: 0.43-0.78).CONCLUSIONThis pilot study showed that DECT can quantify vascular urate deposits withvariation across groups, with gout patients possibly having higher deposition.This relationship disappeared when adjusted for age, and there was a positiverelationship between age and MSU deposition. While this study does not provethat green coded regions are truly MSU deposition, it corroborates recent studiesthat show the presence of vascular deposition.