Therapeutic advances in musculoskeletal disease · 2026
Precision imaging biomarkers for gout: artifact-specific spectral CT parameters for personalized differentiation of tophi in a prospective study.
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Zhang Yiteng, Zhang Yu, Liu Yi, Li Hanyu, Liang Zejun, He Jianrong, Xie Jun, Li Zhenlin, Tang Jing
Аннотация
BACKGROUND: Spectral computed tomography (CT) enables non-invasive visualization and quantification of monosodium urate deposits and has an important role in gout diagnosis and monitoring. However, artifact-related false-positive findings may reduce diagnostic confidence, particularly when artifacts show attenuation features overlapping with tophi.
OBJECTIVES: To evaluate advanced spectral CT parameters as quantitative imaging biomarkers for differentiating tophi from common artifacts.
DESIGN: Prospective cross-sectional study.
METHODS: Consecutive participants with suspected foot gout were prospectively recruited from May 2023 to May 2024 and underwent foot spectral CT scans. Participants were classified into gout and non-gout groups. Regions of interest (ROIs) were delineated on index tophi in the gout group and on artifact regions in the non-gout group, including nail bed, skin, beam-hardening, vascular, and tendon artifacts. Conventional attenuation (HU120-kV) and three advanced spectral parameters (effective atomic number (Zeff), electron density (ED), and dual-energy ratio (DER)) were measured and compared. Diagnostic performance of each parameter was assessed using receiver operating characteristic curves and the area under the curve (AUC).
RESULTS: The final analysis included 82 tophus ROIs and 243 artifact ROIs. Tophi differed significantly from beam-hardening, vascular, and tendon artifacts across all parameters (p < 0.001). ED (AUC = 0.848-0.939) and HU120-kV (AUC = 0.819-0.935) showed the most consistent performance for overall artifacts, beam-hardening, vascular, and tendon artifacts, with no significant difference between them. In contrast, discrimination of nail bed and skin artifacts was more limited. DER (AUC = 0.728) and Zeff (AUC = 0.722) provided complementary values for nail bed artifacts, while ED showed the highest AUC for skin artifacts (AUC = 0.740).
CONCLUSION: Spectral CT parameters may support artifact-specific tophus differentiation in gout. An artifact-specific parameter selection approach may help reduce false-positive interpretations and improve confidence in spectral CT-based gout assessment.
TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2300069114, https://www.chictr.org.cn/showproj.html?proj=185804.
OBJECTIVES: To evaluate advanced spectral CT parameters as quantitative imaging biomarkers for differentiating tophi from common artifacts.
DESIGN: Prospective cross-sectional study.
METHODS: Consecutive participants with suspected foot gout were prospectively recruited from May 2023 to May 2024 and underwent foot spectral CT scans. Participants were classified into gout and non-gout groups. Regions of interest (ROIs) were delineated on index tophi in the gout group and on artifact regions in the non-gout group, including nail bed, skin, beam-hardening, vascular, and tendon artifacts. Conventional attenuation (HU120-kV) and three advanced spectral parameters (effective atomic number (Zeff), electron density (ED), and dual-energy ratio (DER)) were measured and compared. Diagnostic performance of each parameter was assessed using receiver operating characteristic curves and the area under the curve (AUC).
RESULTS: The final analysis included 82 tophus ROIs and 243 artifact ROIs. Tophi differed significantly from beam-hardening, vascular, and tendon artifacts across all parameters (p < 0.001). ED (AUC = 0.848-0.939) and HU120-kV (AUC = 0.819-0.935) showed the most consistent performance for overall artifacts, beam-hardening, vascular, and tendon artifacts, with no significant difference between them. In contrast, discrimination of nail bed and skin artifacts was more limited. DER (AUC = 0.728) and Zeff (AUC = 0.722) provided complementary values for nail bed artifacts, while ED showed the highest AUC for skin artifacts (AUC = 0.740).
CONCLUSION: Spectral CT parameters may support artifact-specific tophus differentiation in gout. An artifact-specific parameter selection approach may help reduce false-positive interpretations and improve confidence in spectral CT-based gout assessment.
TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2300069114, https://www.chictr.org.cn/showproj.html?proj=185804.