Multi-Energy Spectral Photon-Counting CT May Improve Diagnosis of Crystal Arthritis

Researchers examined the clinical utility of multi-energy spectral photon-counting CT in crystal arthritis.

The use of multi-energy spectral photon-counting computed tomography (CT) imaging may improve detection and differentiation of crystal deposits in patients with crystal arthritis, according to results from a study published in Arthritis & Rheumatology.

Researchers conducted an imaging study of a surgically excised finger containing gouty tophus and other crystal deposits. The finger was evaluated using x-ray, dual-energy CT, and multi-energy spectral photon-counting CT imaging, and the results of the 3 techniques were compared. In addition, the investigators collected samples of the crystal deposits and assessed them using either radiographic defraction or light microscopy to validate the imaging results.

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After evaluation, the researchers found that multi-energy spectral photon-counting CT imaging was able to identify, quantify, and differentiate monosodium urate deposits in the excised finger. In addition, they reported that while x-ray and dual-energy CT were able to identify the crystal deposits, multi-energy spectral photon-counting CT provided greater detail.

“With these initial data, we are now in a position to demonstrate that we can replicate the image quality we achieved for ex-vivo samples in live subjects with crystal deposition diseases,” the researchers wrote.

“Further work using samples with smaller urate and calcium burden will be required to determine the diagnostic accuracy and lower limit of detection of [monosodium urate] and calcium crystal deposits using multi-energy [spectral photon-counting CT],” they concluded.


Stamp LK, Anderson NG, Becce F, et al. Clinical utility of multi-energy spectral photon-counting CT in crystal arthritis [published online February 4, 2019]. Arthritis Rheumatol. doi: 10.1002/art.40848