To the Editor We read the recent article by Klauser et al1 with great interest. While the potential implications of the findings are exciting, we have several concerns. First, the authors do not explicitly state whether electrocardiogram gating was used in their study. This is an important detail because cardiac motion artifact is a source of artifactual coloration with dual-energy computed tomography (DECT),2 particularly with dual-source scanners given the approximately 80-millisecond temporal difference between the 2 radiography beams.3 Furthermore, beam hardening artifact from calcified atheromas and partial volume effect, known sources of artifacts in the 2-material decomposition algorithm of DECT, may largely explain the findings.2 While patients with gout had higher prevalence of coronary calcification (55 of 59 patients [93%]) and cardiovascular monosodium urate (MSU) deposition (51 of 59 patients [86%]) than controls, the authors do not report whether the 4 patients with gout without coronary calcifications exhibited MSU deposition nor the number of controls or cadaveric hearts with coronary calcification. The images from the article show areas of green pixelization occurring adjacent to calcified plaques on grayscale computed tomography images (eg, Figure 2A and D,1 left anterior descending artery [yellow arrowhead]), which would favor this artifact hypothesis without additional data.
Becce F, Ghoshhajra B, Choi HK. Identification of Cardiovascular Monosodium Urate Crystal Deposition in Patients With Gout Using Dual-Energy Computed Tomography. JAMA Cardiol. Published online February 05, 2020. doi:10.1001/jamacardio.2019.5804
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