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Is there a DECT machine in or around Portland Oregon?? I believe I have gout and can’t prove it.? Need a defintive diagnosis. It is in my hands and the joints don’t contain enough synovial fluid to have that test.
It is not just a question of where DECT scanners are installed – they also need to be fitted with the syngo DE (Dual Energy) Gout application. I have had great difficulty finding anyone in Siemens who can provide up-to-date installation details.
It is a couple of years since I tried, so the information might be easier to get now. Why not try:
Siemens Medical Solutions USA, Inc.
51 Valley Stream Parkway
Malvern, PA 19355
Phone: +1 888 826 9702
Phone: +1 610 448 4500
Fax: +1 610 448 2554Please let us know if you get anywhere. I would love to offer a locating service, but I do not have the resources for finding a suitable contact and maintaining a dialog.
Having said all that, the best chance of locating an appropriate service must be your rheumatologist. What did he/she suggest after failing to draw synovial fluid? Most rheumatologists have enough experience of gout to be able to diagnose from other criteria.
One thing that DECT has taught us is that crystals often occur in joints that are not currently affected by gout. What is your rheumatologist’s view on drawing a sample from a foot or knee joint?
Finally, what are your uric acid levels? Best taken when you are not having a flare, but in any case, to aid diagnosis, you should get a uric acid blood test every 2 weeks for a couple of months. That, together with the way your symptoms present should be enough to confirm or deny gout.
STOP PRESS
I’ve found some information on syngo installations in the US. This does not mean they have the gout application. Apparently 8 of the top 10 US hospitals have syngo:
John Hopkins Hospital, Baltimore
Massachusetts General Hospital, Boston
Cleveland Clinic, Ohio
Ronald Reagan UCLA Medical Center, CA
New York Presbyterian Medical Center, NY
Brigham and Women’s Hospital, Boston
Duke University Medical Center, Durham, NC
Hospital of the University of PennsylvaniaThe 2 that do not have it (at March 2012):
Mayo Clinic, Rochester, Minnesota
UCSF Medical Center, San FranciscoAlso, I’ve looked in PubMed for all the DECT gout references. Here is a list of institutions:
- University of Auckland, Auckland, New Zealand
- Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, Canada
- Boston University School of Medicine, Boston, MA 02118, USA
- Department of Radiology, PUMC Hospital, Beijing 100730, China
- Hacettepe University School of Medicine, Ankara, Turkey
- Klinikum Wels Grieskirchen, Osterreich
As this is the latest discussion regarding DECT and gout, I’ll add some news here.
Many moons ago, I wrote about DECT in the context of Gouty Tophi & Bone Erosion. I quoted some research from Nicola Dalbeth in New Zealand, and it seems she has continued to research this topic.
In a recently published letter to a European journal for rheumatic diseases, several researchers from the University of Aukland, have warned against over-reliance on DECT technology. They claim exclusive comparisons with other advanced imaging technology reveals a weakness with DECT. In “DECT urate deposits: now you see them, now you don’t” they argue that a specific weakness of the DECT system is it’s reliance on getting the software setup properly. Unlike techniques that rely on medical interpretation, the DECT gout recognition software interprets results based on settings within the program. Get those settings wrong, and you do not see the gout crystals.
The authors point out:
When performing DECT to detect urate deposits in gout, the slope of the line separating urate from calcium-containing voxels [values] is extremely important. Two points may be very close together on the 2D plot (indicating similar density), but if they are on opposite sides of this line, one receives positive color coding and the other negative. The slope of this line is dictated by the ‘parameter ratio’ which may be arbitrarily set
My feelings are that DECT may well be a great timesaver in future, but we are a long way from widespread availability with trustworthy techniques. As always with gout, if there are complications, your best option is to consult a rheumatologist.
Isn’t it amazing that the oldest diagnosable disease now needs complicated multi-million dollar electronic machines to diagnose?
Perhaps some of our GP’s need training in something besides how to use a sphygmomanomenter to measure blood pressure.
Forget the machinery, If you have a very high uric acid and your pain is greatly relieved by dosing with colchicine, you have gout.
The ancient Greeks made the diagnosis without even being able to measure uric acid…or blood pressure.
I guess we have NOT “come a long way, baby.”
Hi, Keith.
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