Evidence map›Paper›PMID 33532938›Full record

ArticleSkeletal radiology2021

Limitations of dual-energy CT in the detection of monosodium urate deposition in dense liquid tophi and calcified tophi.

Se Jin Ahn, Dawen Zhang, Benjamin D Levine, Nicola Dalbeth, Bregina Pool, Veena K Ranganath, Prosper Benhaim, Scott D Nelson, Scott S Hsieh, John D FitzGerald

Abstract read
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In one paragraph

Article in Skeletal radiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
1.8field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 27 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 3 countries.

Se Jin AhnDepartment of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA. sejinahn@uw.edu.ORCID http://orcid.org/0000-0003-2155-470X
Dawen ZhangDepartment of Medicine, University of Illinois, Chicago, IL, USA.
Benjamin D LevineDavid Geffen School of Medicine, Department of Radiology, University of California, Los Angeles, CA, USA.
Nicola DalbethDepartment of Medicine, University of Auckland, Auckland, New Zealand.
Bregina PoolDepartment of Medicine, University of Auckland, Auckland, New Zealand.
Veena K RanganathDavid Geffen School of Medicine, Department of Medicine, University of California, Los Angeles, CA, USA.
Prosper BenhaimDavid Geffen School of Medicine, Department of Surgery, University of California, Los Angeles, CA, USA.
Scott D NelsonDavid Geffen School of Medicine, Department of Pathology, University of California, Los Angeles, CA, USA.
Scott S HsiehDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
John D FitzGeraldDavid Geffen School of Medicine, Department of Surgery, University of California, Los Angeles, CA, USA.
University of California, Los Angeles · USUniversity of Auckland · NZMayo Clinic in Arizona · USUniversity of Illinois Chicago · USUniversity of Washington · USWest Los Angeles College · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveDual-energy CT (DECT) detection of monosodium urate (MSU) crystal deposition has demonstrated good sensitivity and specificity in patients with established gout. However, limitations have been reported with early disease and with low urate burden. We aimed to study the performance of DECT in the detection and quantification of MSU deposition in solid and liquid tophi. MATERIALS AND

methodsPatient-derived solid and liquid tophi, suspensions of commercial synthetic, and in-house synthetic MSU crystals were prepared at varying concentrations. DECT was performed at 80 kVp and 150 kVp, and post-processed using Syngo Via gout software (Siemens) that color-coded urate and cortical bone as green and purple, respectively. DECT findings were correlated with ultrasound and microscopic findings. The protocol was reviewed by IRB and considered a non-human subject research.

resultsDECT did not detect urate deposition in either patient-derived liquid tophi or in-house synthetic crystals at any concentration. Lowering the post-processing minimum threshold increased the detection of in-house synthetic crystals but did not change the detection of patient-derived liquid tophi. Areas of calcium-rich purple color-coded regions, masking detection of urate, within the solid tophi and surrounding liquid tophi were noted on DECT. Histology showed co-presence of calcium along with MSU deposition in these.

conclusionThis study illustrates important limitations of DECT for liquid tophi due to subthreshold CT attenuation and for calcified tophi due to the obscuration of urate by calcium. Urate may be either undetectable or underestimated by DECT when these conditions are present.

Indexed as

Arthritis, GoutyGoutHumansTomography, X-Ray ComputedUltrasonographyUric AcidUric AcidComputed tomographyGoutSuspensionsSynovial fluid

Identifiers

PMID33532938
OpenAlexW3127829560

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.