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Contrast-enhanced dual-energy CT improves diagnosis and guided management of suspected inflammatory arthritis of the hand. 

The single-center study, published in the June 2025 issue of Arthritis & Rheumatology, investigators assessed the effectiveness of contrast-enhanced dual-energy CT (CE-DECT) in detecting and differentiating rheumatic joint diseases of the hand.  

They consecutively enrolled patients with suspected hand arthritis during standard clinical care. The CE-DECT was performed before and after 3 minutes administering a weight-adjusted contrast agent. Reconstructions included 2-material decomposition for tophus visualization, virtual non-calcium for bone marrow edema, and CT subtraction for soft-tissue inflammation, 2 radiologists reviewed all post-processed and original CT images by consensus to establish imaging diagnoses. The CE-DECT findings were compared with initial and final assessments by rheumatologists. The evaluation focused on surrogate performance measures to determine CE-DECT’s added diagnostic value in identifying imaging biomarkers of different arthritic diseases. A follow-up survey rated CE-DECT’s diagnostic usefulness and influence patient management on a 1-to-10 scale. Descriptive statistics were used for analysis.  

The results showed that 136 patients were analyzed. The CE-DECT findings matched the final diagnosis in 119 patients (87.5%). Diagnosis changed after CE-DECT in 67 patients (49.2%). Rheumatologists rated CE-DECT’s diagnostic utility at a mean of 8.5 (SD 2.1) and its impact on patient management at 8.4 (SD 1.8).  

Investigators concluded that CE-DECT demonstrated significant diagnostic and management value for suspected inflammatory arthritis and could become a vital part of clinical workup. 

Source: acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.43270