Gout: Update on Dual-Energy Computed Tomography with Emphasis on Artifact Identification

Gout is the most common inflammatory arthritis and is increasing in prevalence and incidence in many countries worldwide. Accurate diagnosis is important to direct treatment that may include chronic medication. Burden quantification and treatment monitoring are key in the effective care of patients with gout. This review highlights the positive impact of dual-energy computed tomography (DECT) on the evaluation of gout patients and discusses common imaging artifacts that limit this imaging modality. DECT has become the most accurate imaging method for confirming or excluding gout. Of note, however, it has reduced sensitivity in early disease, including initial attacks. Burden quantification is another important role of DECT, which can now be performed using automated software methods, allowing for a more reliable assessment of treatment effect. However, the analysis of gout DECT images can be impeded by artifacts related to the DECT reconstruction technique. DECT is the most sensitive and specific imaging modality for diagnosis, burden quantification, and treatment monitoring in patients with gout. A working knowledge of common DECT artifacts is essential for mitigating their occurance and misinterpretation.