The increase in the use of dual-energy computed tomography (DECT) validates its clinical value in the diagnosis and management of gout, according to the results of a retrospective study published in the Canadian Association of Radiologists Journal.
Researchers analyzed 1877 radiology reports of DECT gout scans between 2007 and 2016 to examine trends of use, referral patterns, indication, and diagnosis. They found that DECT gout referrals increased substantially, going from 37 in 2007 to 385 in 2016.
Results showed that the largest number of referrals were from rheumatology (n=1160), emergency medicine (n=283), and family medicine (n=177). The majority of referrals (92%) were requested to aid an initial diagnosis of gout, whereas 6% were requested to estimate disease burden and 2% were requested to monitor disease progression and effectiveness of treatment.
The investigators noted that imaging findings were similar in referrals from rheumatology (62%), family medicine (62%), and other medical specialties (62%). In addition, the urate positive rates were slightly lower in referrals from emergency medicine and surgical specialties. Calcium pyrophosphate dehydrate crystal deposition disease and other inflammatory or erosive arthritides were the most common differential diagnoses in rheumatology and family medicine.
“The comparable urate positive rates among different referring specialties, combined with diverse patient populations and clinical presentations, support the notion of providing direct access of DECT gout imaging to various physician specialties,” the authors noted.
Gong B, Shojania K, Khosa F, Nicolaou S. Referral patterns for dual-energy computed tomography in diagnosis and management of gout: ten-year experience at a Canadian institution [published online September 21, 2018]. Can Assoc Radiol J. doi: 10.1016/j.carj.2018.06.003