CT Area of Interest With IV Contrast There is no relevant literature supporting the use of CT area of interest with IV contrast for the evaluation of gout in the extremities following initial radiographs. CT Area of Interest Without and With IV Contrast There is no relevant literature supporting the use of CT area of interest without and with IV for the evaluation of gout in the extremities following initial radiographs. CT Area of Interest Without IV Contrast DECT allows visualization of monosodium urate deposition with a sensitivity ranging from 81% to 88% and a specificity ranging from 90% to 93% [47-49]. However, DECT is less accurate in early stages of gout, with a sensitivity in initial stages of gout flare (<6 weeks) ranging between 36% and 80% [15,47]. Sensitivity is also low for deeper structures such as the shoulder and hip [16]. DECT outperforms clinical assessment in the diagnosis of gout [50] and has been shown to be more sensitive for the diagnosis of gout compared to US in studies of patients in mixed stages of disease [51-53]. DECT has been shown to be helpful in assessment of tophus resolution in response to treatment [54]. Although conventional CT area of interest without IV contrast can show characteristic osseous erosions and soft tissue tophi [38], the 2018 EULAR recommendations state that conventional CT without IV contrast has limited utility for diagnosis of gout compared with US and DECT [55]. However, for the purposes of this document, DECT is considered a technique categorized under this procedure subheading. FDG-PET/CT Whole Body There is no relevant literature supporting the use of FDG-PET/CT whole body for the evaluation of gout in the extremities following initial radiographs. Chronic Extremity Joint Pain Image-Guided Aspiration Area of Interest Image-guided aspiration may be helpful in confirming and characterizing crystal deposition disease and excluding infection.
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. CT Area of Interest With IV Contrast There is no relevant literature supporting the use of CT area of interest with IV contrast for the evaluation of gout in the extremities following initial radiographs. CT Area of Interest Without and With IV Contrast There is no relevant literature supporting the use of CT area of interest without and with IV for the evaluation of gout in the extremities following initial radiographs. CT Area of Interest Without IV Contrast DECT allows visualization of monosodium urate deposition with a sensitivity ranging from 81% to 88% and a specificity ranging from 90% to 93% [47-49]. However, DECT is less accurate in early stages of gout, with a sensitivity in initial stages of gout flare (<6 weeks) ranging between 36% and 80% [15,47]. Sensitivity is also low for deeper structures such as the shoulder and hip [16]. DECT outperforms clinical assessment in the diagnosis of gout [50] and has been shown to be more sensitive for the diagnosis of gout compared to US in studies of patients in mixed stages of disease [51-53]. DECT has been shown to be helpful in assessment of tophus resolution in response to treatment [54]. Although conventional CT area of interest without IV contrast can show characteristic osseous erosions and soft tissue tophi [38], the 2018 EULAR recommendations state that conventional CT without IV contrast has limited utility for diagnosis of gout compared with US and DECT [55]. However, for the purposes of this document, DECT is considered a technique categorized under this procedure subheading. FDG-PET/CT Whole Body There is no relevant literature supporting the use of FDG-PET/CT whole body for the evaluation of gout in the extremities following initial radiographs. Chronic Extremity Joint Pain Image-Guided Aspiration Area of Interest Image-guided aspiration may be helpful in confirming and characterizing crystal deposition disease and excluding infection.