1. Dual-energy computed tomography identified cardiovascular monosodium urate deposits reliably, with increased frequency of deposits found in patients with gout.
Evidence Rating Level: 2 (Good)
Hyperuricemia has been identified as a cardiovascular risk factor, and previous studies have demonstrated an association between gout and coronary heart disease. As such, there is interest in differentiating cardiovascular monosodium urate deposits from calcium deposits that may have implications in the treatment of patients with gout at risk of cardiovascular disease. To date, direct cardiovascular imaging of monosodium urate deposits using dual energy computed tomography (DECT) has not been reported on. The objective of this study was to evaluate whether DECT detection of cardiovascular monosodium urate deposits can distinguish patients with gout. This diagnostic study included 59 patients with gout and 47 controls (January 2017 to November 2018), all of whom underwent DECT for evaluation of coronary calcium scoring and monosodium urate deposition. Six cadavers were also included, for whom DECT for monosodium urate deposition evaluation was also conducted. The primary outcome was detection rate of cardiovascular (CV) monosodium urate deposits. Overall, 86.4% of patients with gout had CV monosodium urate deposits compared to 14.9% controls. Coronary calcium scoring was also significantly higher in patients with gout (900 Agatston units (AU), 95% CI 589 AU to 1211 AU) compared to controls (263 AU, 95% CI 76 AU to 451 AU) (p=0.001), and higher in patients with CV monosodium urate deposition. The findings of this study therefore suggest that DECT may be used as a modality to detect CV monosodium urate deposits, which are more prevalent in patients with gout, associated with higher coronary calcium scores, and therefore associated with higher CV risk.
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