BACKGROUND: Dual Energy Computed Tomography (DECT) is a technology that allows for viewing computed tomography spectral images. This method, due to ability of presenting specific elements and substances (like water, calcium and iodine), can be used to locate selected type of tissues. Thyroid tissue due to being rich in endogenous iodine, can be located even without administration of contrast agent.
METHODS: In presented cases authors used a feature of accumulating endogenous iodine in thyroid derivative tissue for diagnosis of differentiated thyroid cancer metastases. In Patient One DECT was a decisive parameter qualifying for the surgery. Due to use of DECT in Patient Two it was possible to directly localize thyroid cancer metastases, which was unfeasible using standard techniques (scintigraphy and [18 F]FDG PET/CT). It helped to perform targeted biopsy and confirm diagnosis of thyroid cancer metastases, allowing to introduce treatment with sorafenibe.
CONCLUSIONS: DECT confirmed its utility in locating thyroid tissues, including differentiated thyroid cancer (DTC) metastases. The method could be used in the future, especially in borderline or ambiguous cases with no localization of DTC in ultrasonography, RAI scintigraphy, or [18 F]FDG PET/CT, and among patients having contraindications for contrast-CT.

Gout is inflammatory arthritis and is easily recognizable by healthcare providers by its typical clinical presentation of acute gout flare or by the presence of chronic tophaceous deposits. However, chronic gouty arthropathy can be more challenging to diagnose in some cases, especially in the absence of a previous history of gout and other characteristic findings on exam. We present a case of chronic gouty arthropathy with features mimicking rheumatoid arthritis involving multiple small joints of hands and feet and other large joints. He had high serum uric acids and a dual-energy CT (DECT) scan of the feet and ankles was obtained which showed polyarticular gout. He was started on pegloticase in view of joint erosions, and severe limitations in activity which resulted in a lowering of monosodium urate crystals and symptomatic improvement.

UNASSIGNED: Severe spinal pain is an unusual presentation of gout. Due to its rarity and the difficulty of obtaining joint fluid or tissue for crystal analysis, dual energy computed tomography (DECT) may be a useful imaging modality in the management of axial gout.
UNASSIGNED: Two patients independently presented to a major teaching hospital with severe spinal pain subsequently shown to be due to gout. The first patient presented with back pain and fevers and was initially thought to have lumbar facet joint septic arthritis. The second case presented with severe back pain. In both cases, DECT suggested monosodium urate deposition in spinal tissues as the cause of their presentation.
UNASSIGNED: Axial gout should be considered in the differential diagnosis of severe spinal pain. A DECT study may be a useful diagnostic tool in the management of spinal gout.

Gout is a common form of inflammatory arthritis, and the majority of gout patients experience recurrent acute attacks, joint damage, and other complications. Carpal tunnel syndrome caused by gouty tophi indicates the severity of untreated gouty tophi. In this article, we report a 54-year- old male chronic gout patient with serious carpal tunnel syndrome secondary to monosodium urate crystal deposit. The patient was admitted to our department with palmar numbness and disability for two years. He had a history of gout for 30 years but received no treatment. Multiple monosodium urate crystals were observed to be deposited in and around carpal tunnel on the three-dimensional reconstruction using dual energy computed tomography, which confirmed the diagnosis. The needle biopsy and electrophysiological test also supported the diagnosis. Our case indicates that dual energy computed tomography is a useful method to diagnose carpal tunnel syndrome associated with gout and that we should keep in mind the possibility of gouty tophi as a possible cause of carpal tunnel syndrome.