Dual energy CT for the diagnosis of gout: Evaluating the optimal Hounsfield unit setting for dual energy processing

Christin A. Tiegs-Heiden , Francis I. Baffour , Garret M. Powell , Shuai Leng , Matthew P. Johnson , Katrina N. Glazebrook
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Abstract

Rationale and objectives

Dual-energy CT (DECT) plays an important role in the evaluation of gout based on its ability to identify monosodium urate (MSU) crystals. Post-processing of DECT includes selection of a minimum Hounsfield unit (HU) threshold, currently set at 150 HU. Adjustments to this setting will affect the amount of MSU that is identified, with lower thresholds identifying more true and false positive MSU. The purpose of this study is to assess the performance of several HU thresholds.

Materials and methods

134 DECTs were reprocessed with minimum HU thresholds set to 150, 140, 130, and 120 HU. Volume of MSU detected was compared across thresholds. Subsequently, readers reviewed 3D axial images from 109 cases at 150, 130, and 120 HU thresholds. For each case, the reader made a diagnosis of gout, rated their confidence, and reported the location of MSU deposits.

Results

Mean MSU volume detected was as follows: 0.160 at 150, 0.205 at 140, 0.276 at 130, and 0.444 at 120 HU. Based on reader diagnosis, there was no significant difference in sensitivity for the diagnosis of gout between the 150 (68.8%), 130 (71.8%), and 120 (69.7%) HU thresholds (p = 0.653). Specificity was higher at 150 HU (65.4%) than at 130 (58.4%) and 120 (52.2%), (p < 0.001). Mean reader confidence was 90.1 for 150 HU, 79.9 for 130 HU, and 74.0 for 120 HU (p < 0.001).

Conclusion

Between the 150, 130, and 120 HU thresholds, 150 HU performed best overall for making the diagnosis of gout on DECT. Further research is needed to determine if there is utility for utilizing lower threshold settings for certain clinical scenarios.

诊断痛风的双能量 CT:评估双能量处理的最佳 Hounsfield 单位设置
理由和目标双能 CT(DECT)能够识别单钠尿酸盐(MSU)结晶,因此在痛风的评估中发挥着重要作用。DECT 的后处理包括选择最小 Hounsfield 单位 (HU) 阈值,目前设定为 150 HU。对这一设置的调整将影响识别出的 MSU 量,阈值越低,识别出的 MSU 真阳性和假阳性越多。本研究的目的是评估几个 HU 阈值的性能。材料和方法134 DECTs 在最小 HU 阈值设置为 150、140、130 和 120 HU 时进行再处理。比较不同阈值检测到的 MSU 体积。随后,读者以 150、130 和 120 HU 的阈值查看了 109 个病例的三维轴向图像。对于每个病例,读者都要做出痛风的诊断,评定其可信度,并报告 MSU 沉积的位置:150HU时为0.160,140HU时为0.205,130HU时为0.276,120HU时为0.444。根据读者诊断,150 HU(68.8%)、130 HU(71.8%)和 120 HU(69.7%)阈值对痛风诊断的敏感性无显著差异(p = 0.653)。150 HU 的特异性(65.4%)高于 130 HU(58.4%)和 120 HU(52.2%)(p < 0.001)。结论在 150、130 和 120 HU 临界值之间,150 HU 在 DECT 诊断痛风方面的总体表现最佳。还需要进一步研究,以确定在某些临床情况下使用较低的阈值设置是否有用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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