Clinical Impact of Multiparametric Contrast-Enhanced Dual-Energy Computed Tomography in Arthritis Imaging: A Prospective Single-Center Study.

OBJECTIVE

We aimed to evaluate the influence of contrast-enhanced dual-energy computed tomography (CE-DECT) in detecting and differentiating rheumatic joint diseases of the hand.

METHODS

In this prospective study, patients with suspected arthritis of the hand were investigated consecutively alongside the standard clinical procedure. CE-DECT with sequential rotations was performed in all patients before and 3-minutes after weight-adapted contrast agent application. Reconstructions included two-material decomposition for tophus imaging, virtual noncalcium for bone marrow edema, and CT subtraction for soft-tissue inflammation. All postprocessed images and original CT reconstructions were rated by two radiologists in consensus to generate an imaging diagnosis. Imaging findings in CE-DECT were juxtaposed with the initial and final evaluations by referring rheumatologists. This evaluation focused on surrogate performance criteria, emphasizing the added diagnostic value of CE-DECT in detecting specific imaging biomarkers associated with various arthritic pathologies. A subsequent survey assessed CE-DECT's diagnostic utility and impact on patient management, rated on a 1 to 10 scale. Descriptive statistics were employed.

RESULTS

Overall, 136 patients were included in the analysis. In 119 patients (87.5%), the CE-DECT findings agreed with the final diagnosis. In 67 patients (49.2%), the diagnosis was changed following CE-DECT. Rheumatologists rated CE-DECT's diagnostic utility at a mean ± SD of 8.5 ± 2.1 and its contribution to patient management at 8.4 ± 1.8.

CONCLUSION

CE-DECT showed high value for diagnosis and management of patients with suspected inflammatory arthritis. Its diverse diagnostic capabilities suggest that it can develop an important addition to current clinical workup pathways.