Diagnostic value of ultrasound versus dual-energy computed tomography in patients with different stages of acute gouty arthritis.

objectivePrevious studies of the diagnostic accuracy of ultrasound (US) and dual-energy computed tomography (DECT) in patients with gout have reported different results. The aim of this study is to compare the diagnostic value of US and DECT in patients with different stages of acute gouty arthritis.

methodsBased on the presence of monosodium urate (MSU) crystals in the synovial fluid, patients (n = 37) were divided into three groups according to gout duration: early stage (within 1 year, n = 15), middle stage (1 to 3 years, n = 12), and late stage (more than 3 years, n = 10). All the affected joints were examined by US and DECT.

resultsIn the early-stage group, the sensitivity of US was significantly higher than DECT in identifying MSU deposition (66.7% vs 26.6%, p < 0.05), while in the middle- and late-stage groups, the sensitivity of US and DECT was similar. In the early-stage group, the US results in nine joints were positive (four with double contour sign, four with snowstorm sign, and one with both double contour sign and snowstorm sign), while DECT did not show any urate crystal deposits.

conclusionThese findings indicate that US should be the first choice for acute gouty arthritis, especially in patients with early-stage disease.Key Points• Previous studies have compared DECT with US to evaluate the reliability of each method in diagnosing gout but have reported different results, which may be partly due to different gout duration.• In our study, the sensitivity of US was significantly higher than DECT in identifying MSU deposition in the early-stage group, while in the middle- and late-stage groups, the sensitivity of US and DECT was similar.• US should be the first choice for the diagnosis of acute gouty arthritis, especially in patients with early-stage disease.