Use of imaging to evaluate gout and other crystal deposition disorders

Abstract

This review summarizes recent advances in plain radiography and advanced imaging for gout, calcium pyrophosphate dihydrate crystal arthropathy and basic calcium phosphate crystal arthropathy. Plain radiography has diagnostic utility in the crystal-induced arthropathies. A gout radiographic damage index has been recently validated. High-resolution ultrasonography may improve noninvasive diagnosis of the crystal-induced arthropathies, and allow monitoring of intra-articular tophi in clinical trials. Computed tomography provides excellent definition of tophi and bone erosion, and three-dimensional computed tomography assessment of tophus volume is a promising outcome measure in gout. Magnetic resonance imaging is also a reliable method for assessment of tophus size in gout, and has an important role in detection of complications of disease in clinical practice. Emerging imaging techniques include three-dimensional ultrasonography and dual-energy computed tomography. Advanced imaging modalities also offer new insights into the mechanisms of cartilage and bone damage in the crystal-induced arthropathies. Plain radiography and advanced imaging techniques may assist with diagnosis, assessment of disease complications and monitoring of crystal-induced arthropathies. Further study of these techniques will provide significant improvement in patient care and further aid in the understanding of disease pathogenesis.