Differentiating the acute phase of gout from the intercritical phase
with ultrasound and quantitative shear wave elastography
Received: 21 March 2018 / Revised: 27 April 2018 / Accepted: 7 May 2018
European Society of Radiology 2018
Objectives To evaluate the value of ultrasound (US) in differentiating the acute phase of gout from the intercritical phase,
particularly using shear wave elastography (SWE).
Methods 57 gout patients were prospectively enrolled and divided into acute phase and intercritical phase groups. The patients
underwent US and SWE examinations for the first metatarsophalangeal joints with the same protocol. Maximum synovial
thickness was measured. US features were reviewed by two radiologists independently. The maximum (E
) and mean
) elastic moduli of synovium were calculated. Diagnostic performances of US, SWE and combined US and SWE were
Results US findings demonstrated that the colour Doppler flow signal grade in the acute phase was higher than that in the
intercritical phase (p = 0.001), whereas no differences were found for B-mode US features between the two groups (all p>0.05).
For SWE, E
were significantly higher in the intercritical phase than in the acute phase (both p <0.001).Theareas
under the receiver operating characteristic curve (AUROCs) were 0.494–0.553 for B-mode US, 0.735 for colour Doppler US
(CDUS), 0.887 for E
and 0.882 for E
. The combination of CDUS and SWE increased the AUROC, sensitivity and
accuracy significantly in comparison with CDUS alone (all p < 0.001). However, the combined set did not show stronger
diagnostic performance in comparison with SWE alone.
Conclusion SWE increases the diagnostic performance in differentiating the acute phase of gout from the intercritical phase in
comparison with conventional US.
• Colour Doppler flow signal grade is higher in acute phase of gout than in intercritical phase.
• SWE demonstrates that synovium stiffness is higher in intercritical phase of gout than in acute phase.
• SWE increases diagnostic performance in differentiating acute phase of gout from intercritical phase in comparison with
Keywords Musculoskeletal system
ACR American College of Rheumatology
AUROC Area under the receiver operating characteristic
CDUS Colour Doppler ultrasound
DCS Double-contour sign
EULAR European League Against Rheumatism
MSU Monosodium urate
MTPJ Metatarsophalangeal joint
NPV Negative predictive value
PPV Positive predictive value
SWE Shear wave elastrography
* Le-Hang Guo
* Hui-Xiong Xu
Department of Medical Ultrasound, Shanghai Tenth People’s
Hospital, Ultrasound Research and Education Institute, Tongji
University School of Medicine, 301 Yanchangzhong Rd,
Shanghai 200072, China
Department of Nephrology and Rheumatology, Shanghai Tenth
People’s Hospital, Tongji University School of Medicine, 301
Yanchangzhong Rd, Shanghai 200072, China