CE-DECT Demonstrates High Diagnostic Utility in Inflammatory Arthritis of the Hand

A prospective study published in Arthritis & Rheumatology evaluating contrast-enhanced dual-energy computed tomography (CE-DECT) has shown significant diagnostic and management value in patients with suspected inflammatory arthritis of the hand.

The findings support CE-DECT as a promising adjunct to standard rheumatologic assessment, offering targeted imaging of key pathologic features.

The study included 136 patients undergoing CE-DECT as part of their diagnostic workup. Imaging was conducted pre- and 3 minutes post-contrast administration, with advanced post-processing techniques applied to extract clinically relevant biomarkers. These included tophus visualization via 2-material decomposition, bone marrow edema through virtual noncalcium mapping, and soft-tissue inflammation using CT subtraction.

CE-DECT findings aligned with the final rheumatologic diagnosis in 119 patients (87.5%). Notably, imaging results led to a change in diagnosis in nearly half the cases (49.2%), underscoring the method’s influence on clinical decision-making. “In 67 patients, the diagnosis was changed following CE-DECT,” the authors reported, highlighting its impact on refining or correcting preliminary assessments. The added ability to differentiate between rheumatic disease subtypes was a key factor in these adjustments.

Rheumatologists participating in the study strongly endorsed CE-DECT’s clinical utility. The imaging modality received an average score of 8.5 (SD 2.1) for diagnostic utility and 8.4 (SD 1.8) for contribution to patient management on a 10-point scale. These scores reflect the clinicians’ perception of CE-DECT as a valuable tool for enhancing diagnostic precision and guiding therapeutic decisions.

“CE-DECT showed high value for diagnosis and management of patients with suspected inflammatory arthritis,” the study concluded. The authors emphasized the technique’s ability to visualize inflammation, bone changes, and tophaceous deposits within a single imaging session—offering a comprehensive picture not always achievable with standard modalities such as radiography or ultrasound.

Given the complexity of differentiating rheumatic diseases in clinical practice, CE-DECT’s multiparametric imaging approach provides a noninvasive, time-efficient method to support diagnosis. Its integration into rheumatologic pathways could streamline assessments, especially in early or atypical disease presentations.

Reference
Ulas ST, Mews J, Ohrndorf S, et al. Clinical impact of multiparametric contrast-enhanced dual-energy computed tomography in arthritis imaging - a prospective single-center study. Arthritis Rheumatol. Published online June 3, 2025. doi:10.1002/art.43270