Background Dual-energy computed tomography (DECT) detects monosodium urate (MSU) deposits in joints. However, the correlation between coronary atherosclerosis phenotypes and MSU-positive lesions in the cardiovascular system remains unclear. We investigated the correlation between coronary MSU-positive plaques on unenhanced DECT with the coronary atherosclerosis profile at coronary CT angiography. Methods One hundred fifty rheumatologic patients were prospectively enrolled. Sixty of them underwent unenhanced DECT and 128-row DECT coronary angiography. Analysis included CAD-RADS stenosis severity, high-risk plaque (HRP) phenotypes, and coronary artery calcium (CAC) score. Results Of 60 patients, with a mean age of 63.7 years, including 7 females (11.7%), 37 had gout (61.7%), 9 had hyperuricemia (15%), and 14 had other rheumatologic diseases (23.3%). At DECT, 11 (18.3%) had coronary MSU-positive lesions totaling 24 lesions (left anterior descending, 12; right coronary artery, 10; circumflex, 1; left main, 1). HRP phenotypes were identified in 14 of 60 patients (23.3%). The prevalence of HRP was higher in MSU-positive than MSU-negative patients (63.3% versus 14.2%; p = 0.003; odds ratio 9.91; 95% confidence interval [CI]: 2.30–48.41). CAD-RADS and CAC scores correlated with the number of MSU-positive lesions (ρ = 0.412; 95% CI: 0.167–0.609; p < 0.001) and ρ = 0.412; 95% CI: 0.169–0.609; p < 0.001). None of the major cardiovascular risk factors (smoking, hypertension, dyslipidemia, or diabetes) was associated with MSU-positive lesions. Conclusion We found an association between coronary MSU-positive lesions and HRP-phenotypes, as well as a correlation with stenosis severity and calcium burden. MSU-positive lesions may serve as an unenhanced DECT-derived biomarker of increased cardiovascular risk. Relevance statement The detection of coronary MSU-positive lesions by DECT could indicate an increased likelihood of HRP phenotypes. These findings suggest their potential as imaging biomarkers for cardiovascular risk, using unenhanced spectral DECT scans or photon-counting CT. Key Points <UnorderedList Mark="Bullet"> <ItemContent> Identifying gout patients with increased cardiovascular risk remains challenging. </ItemContent> <ItemContent> Coronary MSU-positive lesions detected on unenhanced DECT may be associated with HRP features on coronary computed tomography angiography. </ItemContent> <ItemContent> MSU-positive lesions could serve as biomarkers for cardiovascular risk in gout patients. </ItemContent> </UnorderedList> Graphical Abstract

Association between coronary monosodium urate deposits at DECT and high-risk coronary plaque phenotypes and other features in gout patients

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2025年8月11日

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Pietro G. Lacaita,
Andrea S. Klauser,
Julia Held,
David Haschka,
Gerlig Widmann,
Gudrun M. Feuchtner

摘要

Background

Dual-energy computed tomography (DECT) detects monosodium urate (MSU) deposits in joints. However, the correlation between coronary atherosclerosis phenotypes and MSU-positive lesions in the cardiovascular system remains unclear. We investigated the correlation between coronary MSU-positive plaques on unenhanced DECT with the coronary atherosclerosis profile at coronary CT angiography.

Methods

One hundred fifty rheumatologic patients were prospectively enrolled. Sixty of them underwent unenhanced DECT and 128-row DECT coronary angiography. Analysis included CAD-RADS stenosis severity, high-risk plaque (HRP) phenotypes, and coronary artery calcium (CAC) score.

Results

Of 60 patients, with a mean age of 63.7 years, including 7 females (11.7%), 37 had gout (61.7%), 9 had hyperuricemia (15%), and 14 had other rheumatologic diseases (23.3%). At DECT, 11 (18.3%) had coronary MSU-positive lesions totaling 24 lesions (left anterior descending, 12; right coronary artery, 10; circumflex, 1; left main, 1). HRP phenotypes were identified in 14 of 60 patients (23.3%). The prevalence of HRP was higher in MSU-positive than MSU-negative patients (63.3% versus 14.2%; p = 0.003; odds ratio 9.91; 95% confidence interval [CI]: 2.30–48.41). CAD-RADS and CAC scores correlated with the number of MSU-positive lesions (ρ = 0.412; 95% CI: 0.167–0.609; p < 0.001) and ρ = 0.412; 95% CI: 0.169–0.609; p < 0.001). None of the major cardiovascular risk factors (smoking, hypertension, dyslipidemia, or diabetes) was associated with MSU-positive lesions.

Conclusion

We found an association between coronary MSU-positive lesions and HRP-phenotypes, as well as a correlation with stenosis severity and calcium burden. MSU-positive lesions may serve as an unenhanced DECT-derived biomarker of increased cardiovascular risk.

Relevance statement

The detection of coronary MSU-positive lesions by DECT could indicate an increased likelihood of HRP phenotypes. These findings suggest their potential as imaging biomarkers for cardiovascular risk, using unenhanced spectral DECT scans or photon-counting CT.

Key Points

Identifying gout patients with increased cardiovascular risk remains challenging.

Coronary MSU-positive lesions detected on unenhanced DECT may be associated with HRP features on coronary computed tomography angiography.

MSU-positive lesions could serve as biomarkers for cardiovascular risk in gout patients.

Graphical Abstract