The use of a Dual Energy Computed Tomography Bone Marrow Application in the Diagnosis and Analysis of Gout

Abstract

Gout is a common and treatable form of inflammatory arthritis that is a response to the presence of monosodium urate (MSU) crystal deposition in the soft tissues and joints. It can cause severe joint pain and musculoskeletal abnormalities/disabilities, and is commonly associated with several comorbidities such as metabolic syndrome, hypertension, diabetes and cardiovascular disease. The diagnosis of gout has conventionally been based on a combination of clinical findings, lab tests and joint aspirates, with imaging often used as an adjunct. Advances in medical imaging, particularly in the realm of dual-energy computed tomography (DECT) and vendor software packages, show potential for providing further tools to aid in this process. The prevalence of gout in New Zealand (NZ) has been estimated in a national study using two independent data sources, demonstrating a high overall national prevalence of 2.69% and a prevalence of 3.75% in people aged ≥20 years. This study also confirmed that gout is more common in Maori and Pacific populations, males, the elderly and people living in socioeconomically deprived areas. However, this study was limited in accuracy by the method for detecting gout – only those who presented to the health system and were diagnosed or filled a prescription for gout medication were counted. The study suggests that the data may in fact underestimate the prevalence of gout in NZ due to this method, as there are indications that people with gout may self-manage their gout flares using alternative therapy that are not captured in the health system. Other studies suggest that the prevalence of gout is increasing throughout the rest of the world, with more men effected than women and prevalence increasing with age until it plateaus at age 70.