Gout misdiagnosis due to dual-energy computed tomography artefact

Gout misdiagnosis due to dual-energy computed tomography artefact Maarten van der Linden et al. of the NLRP3 inflammasome is enhanced in lupus neutrophils for NETosis. Arthritis Rheumatol macrophages. J Immunol 2013;190:121726. 2016;68:46272. 19 Rother N, Pieterse E, Lubbers J, Hilbrands L, van der Vlag 21 Lood C, Blanco LP, Purmalek MM et al. Neutrophil J. Acetylated histones in apoptotic microparticles drive extracellular traps enriched in oxidized mitochondrial DNA the formation of neutrophil extracellular traps in active are interferogenic and contribute to lupus-like disease. Nat lupus nephritis. Front Immunol 2017;8:1136. Med 2016;22:14653. 20 Dieker J, Tel J, Pieterse E et al. Circulating apoptotic 22 van der Linden M, Meyaard L. Fine-tuning neutrophil ac- microparticles in systemic lupus erythematosus patients tivation: strategies and consequences. Immunol Lett drive the activation of dendritic cell subsets and prime 2016;178:39. Rheumatology 2018;57:1234 doi:10.1093/rheumatology/key019 Clinical vignette Advance Access publication 21 February 2018 FIG.1 DECT scan of the left knee according to position- Gout misdiagnosis due to dual-energy computed ing of the right prosthetic knee tomography artefact A dual-energy CT (DECT) gout protocol (Fig. 1A) was performed for suspicion of gout of the left knee arthritis in 74-year-old woman with no monosodium urate crystals on initial SF analysis. DECT reconstructions revealed uric acid deposition automatically coloured in green (Fig. 1B, arrows) at the posterior surface of the femoral condyles. However, the localization of crystals deposition was unusual and the arthritis was not improved by colchicine. A new DECT was performed with flexion of the contralateral prosthetic knee (Fig. 1C) and did not show any green pixilation suggestive of gout, thus confirming a metal artefact due to the presence of the knee prosthesis (Fig. 1D). DECT is a valuable, non-inva- sive imaging modality for the diagnosis of gout when urate crystals confirmation in SF is not possible [1]. However, DECT artefacts may lead to a false-positive diagnosis [2], mainly due to skin or beam-hardening artefacts such as in this first described case of DECT metal artefact due to contralateral knee prosthesis. Funding: No specific funding was received from any Coronal DECT reconstructions of a 74-year-old woman bodies in the public, commercial or not-for-profit sectors with left knee arthritis: beam-hardening artefact with to carry out the work described in this article. green pixilation suggestive of gout (arrows) at the pos- terior surface of the left femoral condyles disappears Disclosure statement: The authors have declared no when the contralateral prosthetic knee is flexed. conflicts of interest. References 1 2,3 Andre Ramon , Pierre Pottecher and 1,4 Paul Ornetti 1 Neogi T, Jansen TL, Dalbeth N et al. 2015 Gout classifi- 1 2 cation criteria: an American College of Rheumatology/ Department of Rheumatology, Department of Radiology, Section of Musculoskeletal Imaging and Intervention, Dijon University Hospital, European League Against Rheumatism collaborative LE2I UMR CNRS 6306, Arts et Metiers, University of Burgundy and initiative. Arthritis Rheumatol 2015;67:255768. INSERM 1093 CAPS, University of Burgundy, Dijon, France 2 Mallinson PI, Coupal T, Reisinger C et al. Artifacts in dual- Correspondence to: Paul Ornetti, Department of Rheumatol- energy CT gout protocol: a review of 50 suspected cases ogy, 14 rue Gaffarel, CHU Dijon, 21000 Dijon, France. with an artifact identification guide. Am J Roentgenol E-mail: paul.ornetti@chu-dijon.fr 2014;203:1039. The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com 1234 https://academic.oup.com/rheumatology Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/7/1234/4898125 by Ed 'DeepDyve' Gillespie user on 26 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

Gout misdiagnosis due to dual-energy computed tomography artefact

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com
ISSN
1462-0324
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1462-0332
D.O.I.
10.1093/rheumatology/key019
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Abstract

Maarten van der Linden et al. of the NLRP3 inflammasome is enhanced in lupus neutrophils for NETosis. Arthritis Rheumatol macrophages. J Immunol 2013;190:121726. 2016;68:46272. 19 Rother N, Pieterse E, Lubbers J, Hilbrands L, van der Vlag 21 Lood C, Blanco LP, Purmalek MM et al. Neutrophil J. Acetylated histones in apoptotic microparticles drive extracellular traps enriched in oxidized mitochondrial DNA the formation of neutrophil extracellular traps in active are interferogenic and contribute to lupus-like disease. Nat lupus nephritis. Front Immunol 2017;8:1136. Med 2016;22:14653. 20 Dieker J, Tel J, Pieterse E et al. Circulating apoptotic 22 van der Linden M, Meyaard L. Fine-tuning neutrophil ac- microparticles in systemic lupus erythematosus patients tivation: strategies and consequences. Immunol Lett drive the activation of dendritic cell subsets and prime 2016;178:39. Rheumatology 2018;57:1234 doi:10.1093/rheumatology/key019 Clinical vignette Advance Access publication 21 February 2018 FIG.1 DECT scan of the left knee according to position- Gout misdiagnosis due to dual-energy computed ing of the right prosthetic knee tomography artefact A dual-energy CT (DECT) gout protocol (Fig. 1A) was performed for suspicion of gout of the left knee arthritis in 74-year-old woman with no monosodium urate crystals on initial SF analysis. DECT reconstructions revealed uric acid deposition automatically coloured in green (Fig. 1B, arrows) at the posterior surface of the femoral condyles. However, the localization of crystals deposition was unusual and the arthritis was not improved by colchicine. A new DECT was performed with flexion of the contralateral prosthetic knee (Fig. 1C) and did not show any green pixilation suggestive of gout, thus confirming a metal artefact due to the presence of the knee prosthesis (Fig. 1D). DECT is a valuable, non-inva- sive imaging modality for the diagnosis of gout when urate crystals confirmation in SF is not possible [1]. However, DECT artefacts may lead to a false-positive diagnosis [2], mainly due to skin or beam-hardening artefacts such as in this first described case of DECT metal artefact due to contralateral knee prosthesis. Funding: No specific funding was received from any Coronal DECT reconstructions of a 74-year-old woman bodies in the public, commercial or not-for-profit sectors with left knee arthritis: beam-hardening artefact with to carry out the work described in this article. green pixilation suggestive of gout (arrows) at the pos- terior surface of the left femoral condyles disappears Disclosure statement: The authors have declared no when the contralateral prosthetic knee is flexed. conflicts of interest. References 1 2,3 Andre Ramon , Pierre Pottecher and 1,4 Paul Ornetti 1 Neogi T, Jansen TL, Dalbeth N et al. 2015 Gout classifi- 1 2 cation criteria: an American College of Rheumatology/ Department of Rheumatology, Department of Radiology, Section of Musculoskeletal Imaging and Intervention, Dijon University Hospital, European League Against Rheumatism collaborative LE2I UMR CNRS 6306, Arts et Metiers, University of Burgundy and initiative. Arthritis Rheumatol 2015;67:255768. INSERM 1093 CAPS, University of Burgundy, Dijon, France 2 Mallinson PI, Coupal T, Reisinger C et al. Artifacts in dual- Correspondence to: Paul Ornetti, Department of Rheumatol- energy CT gout protocol: a review of 50 suspected cases ogy, 14 rue Gaffarel, CHU Dijon, 21000 Dijon, France. with an artifact identification guide. Am J Roentgenol E-mail: paul.ornetti@chu-dijon.fr 2014;203:1039. The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com 1234 https://academic.oup.com/rheumatology Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/7/1234/4898125 by Ed 'DeepDyve' Gillespie user on 26 June 2018

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RheumatologyOxford University Press

Published: Feb 21, 2018

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