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Review
. 2011;13(6):246.
doi: 10.1186/ar3489. Epub 2011 Nov 4.

Imaging in gout--what can we learn from MRI, CT, DECT and US?

Fiona M McQueen  1 , Anthony Doyle, Nicola Dalbeth
Affiliations
Review

Imaging in gout--what can we learn from MRI, CT, DECT and US?

Fiona M McQueen et al. Arthritis Res Ther. 2011.

Abstract

There are many exciting new applications for advanced imaging in gout. These modalities employ multiplanar imaging and allow computerized three-dimensional rendering of bone and joints (including tophi) and have the advantage of electronic data storage for later retrieval. High-resolution computed tomography has been particularly helpful in exploring the pathology of gout by investigating the relationship between bone erosions and tophi. Magnetic resonance imaging and ultrasonography can image the inflammatory nature of gouty arthropathy, revealing synovial and soft tissue inflammation, and can provide information about the composition and vascularity of tophi. Dual-energy computerized tomography is a new modality that is able to identify tophi by their chemical composition and reveal even small occult tophaceous deposits. All modalities are being investigated for their potential roles in diagnosis and could have important clinical applications in the patient for whom aspiration of monosodium urate crystals from the joint is not possible. Imaging can also provide outcome measures, such as change in tophus volume, for monitoring the response to urate-lowering therapy and this is an important application in the clinical trial setting.

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Figures

Figure 1
Figure 1
Plain radiograph of the hands of a Pacific islander man with longstanding tophaceous gout. Radiograph shows multiple erosions, some of which are extramarginal. Regions of bony lysis adjacent to soft tissue densities represent tophi.
Figure 2
Figure 2
Three-dimensional reconstruction of helical multidetector computed tomography scan of the foot of a patient with tophaceous gout. Tophi at multiple locations, including adjacent to the metatarsophalangeal and interphalangeal joints of the big toe, are shown. (a) Anteroposterior view and (b) lateral view.
Figure 3
Figure 3
Axial magnetic resonance imaging scans of a large tophus adjacent to the second metatarsal head of a Pacific islander man with longstanding tophaceous gout. (a) T1-weighted (T1w) image reveals low-signal intensity tophus. (b) T1w post-contrast image reveals rim enhancement and a non-enhancing focus indicating fluid within the tophus (arrow). (c) T2-weighted image shows a crescent of fluid (white) corresponding to the non-enhancing focus on contrast-enhanced images.
Figure 4
Figure 4
Ultrasound image of a subcutaneous tophus of mixed echogenicity with adjacent halo region.
Figure 5
Figure 5
Dual-energy computed tomography scan of the foot of a Pacific islander man with longstanding gout. Scan reveals multiple tophaceous deposits adjacent to interphalangeal and tarsal joints as well as the calcaneal bursa, the soft tissues anterior to the ankle joint, and the peroneal tendon sheath.
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