The application value of musculoskeletal ultrasound and dualenergy CT for monosodium urate crystals during the first episode of acute gouty arthritis

Abstract

Objective To evaluate the application value of musculoskeletal ultrasound （MSUS） and dualenergy CT （DECT） in the detection of monosodium urate crystals during the first onset of acute gouty arthritis. Methods Clinical data of 48 patients who presented with the first episode of joint swelling and pain and were diagnosed with acute gouty arthritis were collected. The detection rates of monosodium urate crystals during the first onset of gout by MSUS and DECT were compared. The detection of monosodium urate crystals, bone erosion, joint cavity effusion and synovitis by two tools was analyzed. Results In the acute phase of the first onset of gout, the detection rate of monosodium urate crystals by DECT was 29%, significantly lower than 88% by DECT （P < 0.001）. DECT failed to detect monosodium urate crystals in 31 gout patients （65%）, which could be displayed by MSUS. For 7 patients with the first onset of knee joint, DECT could detect monosodium urate crystals in all 7 patients, whereas MSUS failed to detect monosodium urate crystals in 3 cases. The most common MSUS manifestation of monosodium urate crystals was the “dual track sign”, accounting for 42%, followed by punctate hyperechoic foci （40%） and tophi （29%）. Conclusions Compared with DUCT, MSUS yields higher detection rate of monosodium urate crystals during the first onset of acute gouty arthritis. Hence, it is recommended to employ MSUS to evaluate monosodium urate crystals during the first episode of acute gouty arthritis. For patients presenting with the first onset of knee joint, MSUS combined with DECT is recommended to improve the detection rate of monosodium urate crystals.

Keywords

• |first onset of gout|arthritis|musculoskeletal ultrasound|dualenergy ct|monosodium urate crystal