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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.
Highlights
Gout is a form of inflammatory arthritis that is characterized initially by acute attacks of active synovitis related to the presence of monosodium urate (MSU) crystals in the joints and periarticular soft tissues
This review presents a critical appraisal of the current literature pertaining to advanced imaging in gout and provides specific discussion of these areas related to each modality
The authors concluded that Dual-energy computed tomography (DECT) scanning had potential as a sensitive, quantitative imaging tool for assessing tophus volume changes in patients with tophaceous gout
Summary
Gout is a form of inflammatory arthritis that is characterized initially by acute attacks of active synovitis related to the presence of monosodium urate (MSU) crystals in the joints and periarticular soft tissues. The authors concluded that DECT scanning had potential as a sensitive, quantitative imaging tool for assessing tophus (and urate) volume changes in patients with tophaceous gout. The MRI scoring systems - Rheumatoid Arthritis MRI Score (RAMRIS) and Psoriatic Arthritis MRI Score (PsAMRIS) - are in use in clinical trials and similar systems are being evolved for studies in US [40] The utility of these instruments lies in their ability to reproducibly measure joint inflammation and damage, incorporating characteristic pathological features including bone erosion, bone oedema and synovitis for RA, with additions available for scoring tenosynovitis and cartilage [41,42]. Author details 1Department of Molecular Medicine and Pathology, Faculty of Medicine and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand. 2Department of Radiology, Auckland City Hospital, Auckland District Health Board, Grafton Road, Auckland 1023, New Zealand. 3Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
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