Congress:
RANZCR ASM 2013
Type:
Educational Exhibit
Keywords:
Musculoskeletal joint, CT, Computer Applications-3D, Arthritides
Authors:
F. Tabatabaie Moghadam1, A. Moghaddam1, F. Ghazanfari2; 1Brisbane/AU, 2Melbourne/AU
DOI:
10.1594/ranzcr2013/R-0060
Imaging Findings OR Procedure Details
DECT can accurately characterise MSU deposition and improve clinical diagnosis of unclear arthropathies (5).
The dual source scanner is equipped with two x-ray tubes and allows simultaneous acquisition at two different energy levels (80 and 140 kVp) and subsequent creation of two different datasets that are loaded into the post processing software on a Multi technique CT workstation.
A material decomposition algorithm is then able to differentiate the soft tissue material based on its chemical composition.
This allows accurate and specific characterisation of MSU deposition which could subsequently be colour-coded,
usually green in our institute.
We describe and illustrate imaging findings in four patients who were either clinically diagnosed with or suspected of having gout(6).
DECT scan of a 70 year old man with the background of Gout who developed severe knee and ankle pain following coronary angiogarm.
It depicted Uric acid deposition in green at the knee and ankle joint and tendons.(Fig 1,2)
DECT scan of a 50 year old man with longstding polyarticular tophaceous gout in elbow,
MCPs,
Wrists,
knees and ankles which demonstrates green MSU depostis within the joints and tendons.(Fig 3)
DECT scan of the wirst in a 65 year old man with severe pain and swelling in right wrist,
raised WCC.
The diagnosis was confirmed with identification of the MSU deposits in wrist joint aspirates.(Fig 4)
80 years old man who presented to Emergency Department with fever,
diffuse ankle swelling and neck tenderness,
with no history of trauma.
He had confirmed diagnosis of gout in previous admissions,
however given the severity of the fever and the other symptoms,
there was clinical concern of osteomyelitis.
Ankle washout and Arthroscopy was done in the operation room,
and large amount of MSU crystal within the synovium was detected.
A cervical spine MRI was ordered by the neurosurgens for chronic neck pain.
Sagittal T1 post contrast image showed C3/4 disc height attenuation with abnormal enhancement extending to the epidural and prevertebral spaces,
highly suggestive of discitis.
This patient was a case of polyarticular gout,
including cervical spine,
with evidence of MSU depostis in cervical spine detected by DECT scan.(Fig 5)