Diagnostic Performance of Dual-energy CT Versus Ultrasonography in Gout: A Meta-analysis

Abstract

Objective: Dual-energy computed tomography (DECT), along with ultrasound (US), has been increasingly utilized for the diagnosis of gout because of its noninvasive advantages. However, the superiority of DECT over US remains controversial. This meta-analysis was performed to investigate whether DECT is superior to US in the diagnosis of gout.

Methods: A comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases was conducted for potentially eligible articles. Studies that evaluated the utility of DECT or US for gout diagnosis were qualified. Two distinctive ultrasonographic features of gout, namely, the double contour sign and the presence of tophus, were also assessed. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Besides, the subgroup analyses of early disease duration (≤ 2 years) was also performed.

Results: Twenty-eight studies were included in the meta-analysis. The pooled sensitivity and specificity of DECT were 0.89 (0.80-0.94) and 0.91 (0.88-0.94), respectively. The pooled sensitivity and specificity of US were 0.70 (0.58-0.79) and 0.95 (0.87-0.98), respectively, for double contour sign; 0.57 (0.38-0.74) and 0.99 (0.88-1.00), respectively, for tophus; and 0.84 (0.73-0.91) and 0.84 (0.78-0.89), respectively, for overall consideration of US signs. At the early disease duration (≤ 2 years), the pooled sensitivity and specificity were 0.75 (0.60-0.86) and 0.85 (0.75-0.91), respectively, for DECT; 0.93 (0.72-0.99) and 0.80 (0.71-0.86), respectively, for overall consideration of US signs.

Conclusion: DECT and US showed promising accuracy for gout diagnosis. DECT has higher sensitivity, specificity, and AUC than overall consideration of US signs and thus has a better diagnostic ability in diagnosing gout. Moreover, the diagnostic sensitivity of DECT is lower than that of overall consideration of US signs at less than 2 years' disease duration.

Keywords: DECT; US; diagnosis; gout; meta-analysis.