{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:45:43Z","timestamp":1782449143011,"version":"3.54.5"},"reference-count":59,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100018542","name":"Natural Science Foundation of Sichuan Province","doi-asserted-by":"publisher","award":["2025ZNSFSC0653"],"award-info":[{"award-number":["2025ZNSFSC0653"]}],"id":[{"id":"10.13039\/501100018542","id-type":"DOI","asserted-by":"publisher"}]},{"name":"1.3.5 Project for Disciplines of Excellence from West China Hospital of Sichuan University","award":["2023-318"],"award-info":[{"award-number":["2023-318"]}]},{"name":"1.3.5 Project for Disciplines of Excellence from West China Hospital of Sichuan University","award":["ZYGD23024"],"award-info":[{"award-number":["ZYGD23024"]}]},{"name":"Key R&D Projects of Sichuan Science and Technology Program","award":["2024YFFK0050"],"award-info":[{"award-number":["2024YFFK0050"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82502328"],"award-info":[{"award-number":["82502328"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Clinical Medicine Research Promotion Program of China Medical Foundation","award":["2024CMFA10"],"award-info":[{"award-number":["2024CMFA10"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Musculoskeletal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Spectral computed tomography (CT) enables non-invasive visualization and quantification of monosodium urate deposits and has an important role in gout diagnosis and monitoring. However, artifact-related false-positive findings may reduce diagnostic confidence, particularly when artifacts show attenuation features overlapping with tophi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate advanced spectral CT parameters as quantitative imaging biomarkers for differentiating tophi from common artifacts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Prospective cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Consecutive participants with suspected foot gout were prospectively recruited from May 2023 to May 2024 and underwent foot spectral CT scans. Participants were classified into gout and non-gout groups. Regions of interest (ROIs) were delineated on index tophi in the gout group and on artifact regions in the non-gout group, including nail bed, skin, beam-hardening, vascular, and tendon artifacts. Conventional attenuation (HU\n                      <jats:sub>120-kV<\/jats:sub>\n                      ) and three advanced spectral parameters (effective atomic number (Zeff), electron density (ED), and dual-energy ratio (DER)) were measured and compared. Diagnostic performance of each parameter was assessed using receiver operating characteristic curves and the area under the curve (AUC).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The final analysis included 82 tophus ROIs and 243 artifact ROIs. Tophi differed significantly from beam-hardening, vascular, and tendon artifacts across all parameters (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). ED (AUC\u2009=\u20090.848\u20130.939) and HU\n                      <jats:sub>120-kV<\/jats:sub>\n                      (AUC\u2009=\u20090.819\u20130.935) showed the most consistent performance for overall artifacts, beam-hardening, vascular, and tendon artifacts, with no significant difference between them. In contrast, discrimination of nail bed and skin artifacts was more limited. DER (AUC\u2009=\u20090.728) and Zeff (AUC\u2009=\u20090.722) provided complementary values for nail bed artifacts, while ED showed the highest AUC for skin artifacts (AUC\u2009=\u20090.740).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Spectral CT parameters may support artifact-specific tophus differentiation in gout. An artifact-specific parameter selection approach may help reduce false-positive interpretations and improve confidence in spectral CT-based gout assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>\n                      Chinese Clinical Trial Registry, ChiCTR2300069114,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.chictr.org.cn\/showproj.html?proj=185804\">https:\/\/www.chictr.org.cn\/showproj.html?proj=185804<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Medical Engineering, West China Hospital of Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zejun","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Radiology, West China Hospital of Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianrong","family":"He","sequence":"additional","affiliation":[{"name":"Department of Radiology, West China Hospital of Sichuan University, Chengdu, 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