Abstract
Gout is an ancient disease. Last decade has brought about significant advancement in imaging technology and real scientific growth in the understanding of the pathophysiology of gout, leading to the availability of multiple effective noninvasive diagnostic imaging options for gout and treatment options fighting inflammation and controlling urate levels. Despite this, gout is still being sub-optimally treated, often by nonspecialists. Increased awareness of optimal treatment options and an increasing role of ultrasound and dual energy computed tomography (DECT) in the diagnosis and management of gout are expected to transform the management of gout and limit its morbidity. DECT gives an accurate assessment of the distribution of the deposited monosodium urate (MSU) crystals in gout and quantifies them. The presence of a combination of the ultrasound findings of an effusion, tophus, erosion and the double contour sign in conjunction with clinical presentation may be able to obviate the need for intervention and joint aspiration in a certain case population for the diagnosis of gout. The purpose of this paper is to review imaging appearances of gout and its clinical applications.
Highlights
Gout is the most common cause of inflammatory arthritis in men [1] and its prevalence is rapidly expanding in the general population [2]
This results in supersaturation of uric acid in body tissues and fluids resulting in urate deposition
Acute gout attacks are due to the triggering of an inflammation pathway known as the NALP3 inflammasome by monosodium urate (MSU) crystals in the joint [3] and soft tissues
Summary
Gout is the most common cause of inflammatory arthritis in men [1] and its prevalence is rapidly expanding in the general population [2]. The musculoskeletal manifestations of gout are triggered by the deposition of monosodium urate (MSU) crystals in cartilage, joints, and soft tissues. An experienced clinician or a specialist in gout can make the diagnosis on clinical grounds and laboratory findings and provide optimal management with little or no help from imaging, except in certain cases where the presentation mimics mass lesions or infection or when the deeper structures like the spine and sacroiliac joints are involved. Advanced imaging is very sensitive in demonstrating aggregates of MSU crystals in soft tissue, joint, and bone. MSU crystals in tophaceous deposits around joints and deposits in tendons and soft tissues are well identified by DECT. MRI is the only clinical imaging modality which accurately shows bone marrow edema Both ultrasound with Doppler imaging and MRI with contrast show increased vascularity associated with inflammation surrounding crystal deposits, sometimes even during intercritical periods. The aim of this paper is to review and familiarize the reader with the imaging (radiographs, US, computed tomography (CT), DECT, and magnetic resonance imaging (MRI)) and findings of gout
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