Published online Aug 28, 2020. doi: 10.4329/wjr.v12.i8.184
Peer-review started: March 9, 2020
First decision: April 25, 2020
Revised: June 16, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 28, 2020
Processing time: 167 Days and 14.4 Hours
Gout, caused by hyperuricemia and subsequent deposition of aggregated monosodium urate crystals (MSU) in the joints or extra-articular regions, is the most common inflammatory arthritis. There is increasing evidence that gout is an independent risk factor for hypertension, cardiovascular disease progression and mortality.
To evaluate if dual energy computed tomography (DECT) could identify MSU within vessel walls of gout patients, and if MSU deposits within the vasculature differed between patients with gout and controls. This study may help elucidate why individuals with gout have increased risk for cardiovascular disease.
31 gout patients and 18 controls underwent DECT scans of the chest and abdomen. A material decomposition algorithm was used to distinguish regions of MSU (coded green), and calcifications (coded purple) from soft tissue (uncoded). Volume of green regions was calculated using a semi-automated volume assessment program. Between-group differences were analyzed using Mann-Whitney U exact test and nonparametric rank regression.
Gout patients had significantly higher volume of MSU within the aorta compared to controls [Median (Min-Max) of 43.9 (0-1113.5) vs 2.9 (0-219.4), P = 0.01]. Number of deposits was higher in gout patients compared to controls [Median (Min-Max) of 20 (0-739) vs 1.5 (0-104), P = 0.008]. However, the difference was insignificant after adjustment for age, gender, history of cardiovascular disease and diabetes. Increased age was positively associated with total urate volume (rs = 0.64; 95% confidence interval: 0.43-0.78).
This pilot study showed that DECT can quantify vascular urate deposits with variation across groups, with gout patients possibly having higher deposition. This relationship disappeared when adjusted for age, and there was a positive relationship between age and MSU deposition. While this study does not prove that green coded regions are truly MSU deposition, it corroborates recent studies that show the presence of vascular deposition.
Core tip: There is increasing evidence that gout is an independent risk factor for cardiovascular disease progression. In hyperuricemic individuals, monosodium urate may be deposited within the vessel wall and possibly lead to an inflammatory cascade. We examine if dual energy computed tomography can quantify monosodium urate depositions in the vasculature of gout patients, and measure deposits volumetrically to see if they are higher in these individuals compared to healthy controls. The study shows that dual energy computed tomography can detect vascular deposits and that gout patients possibly have increased deposition, and corroborates recent studies that show the presence of vascular deposition.