Cailin Conner

DocwireNews

A phantom study and clinical illustration published in <a href="https://eurradiolexp.springeropen.com/articles/10.1186/s41747-023-00348-7" target="_blank" rel="noopener">European Radiology Experimental</a> found that the use of lower iodinated contrast medium (ICM) concentrations improved detection of low and medium uric acid concentrations with dual-energy computed tomography (DECT) in patients with gouty arthritis.&ldquo;Since patients with unclear arthritis undergoing contrast-enhanced multiparametric DECT may also suffer from gout, currently an unenhanced DECT is performed routinely beforehand due to the unknown effect of ICM on the detection of [monosodium urate (MSU)],&rdquo; the investigators wrote. &ldquo;Therefore, the aim of this study was to systematically analyze whether, and if so how, the presence of ICM influences the detection of MSU in different ex vivo phantom settings.&rdquo;The study included 2 types of phantoms&mdash;a grid-like phantom and a biophantom&mdash;each having suspensions with varying concentrations of ICM (range, 0%-2%) and MSU (range, 0%-50%). Through a series of DECT scans, the researchers explored how different ICM concentrations affected the detection of MSU crystals.Lower concentrations of ICM (0.25% and 0.50%) enhanced the detection of small uric acid concentrations by an impressive 35% to 45% compared with scans conducted without ICM. &ldquo;However, high ICM concentrations (1% and 2%) almost completely precluded MSU detection for all MSU concentrations investigated,&rdquo; according to the researchers.The researchers also presented a real-world case of a patient suffering from gouty arthritis. The results of the clinical example found that the visualization of tophi in the wrist was only achieved after intravenous administration of ICM.&ldquo;The clinical impact of our findings has yet to be demonstrated in further studies,&rdquo; they concluded. &ldquo;For now, the authors recommend adding an unenhanced scan to contrast-enhanced protocols when gouty arthritis is suspected.&rdquo;

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Low Iodine Concentrations During DECT Yield Improved Uric Acid Detection

Gout

Combining iodinated contrast medium with dual-energy CT enhanced the detection of monosodium urate crystals in gout, but excessive contrast may obscure crystal visibility.

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