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Imaging of gout: findings and utility.

Perez-Ruiz F, Dalbeth N, Urresola A, de Miguel E, Schlesinger N - Arthritis Res. Ther. (2009)

Bottom Line: Computed tomography may best evaluate bone changes, whereas magnetic resonance imaging is suitable to evaluate soft tissues, synovial membrane thickness, and inflammatory changes.Ultrasonography is a tool that may be used in the clinical setting, allowing evaluation of cartilage, soft tissues, urate crystal deposition, and synovial membrane inflammation.Also ultrasound-guided puncture may be useful for obtaining samples for crystal observation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Rheumatology Division, Hospital de Cruces, Baracaldo, Vizcaya, Spain. fernando.perezruiz@osakidetza.net

ABSTRACT
Imaging is a helpful tool for clinicians to evaluate diseases that induce chronic joint inflammation. Chronic gout is associated with changes in joint structures that may be evaluated with diverse imaging techniques. Plain radiographs show typical changes only in advanced chronic gout. Computed tomography may best evaluate bone changes, whereas magnetic resonance imaging is suitable to evaluate soft tissues, synovial membrane thickness, and inflammatory changes. Ultrasonography is a tool that may be used in the clinical setting, allowing evaluation of cartilage, soft tissues, urate crystal deposition, and synovial membrane inflammation. Also ultrasound-guided puncture may be useful for obtaining samples for crystal observation. Any of these techniques deserve some consideration for feasibility and implementation both in clinical practice and as outcome measures for clinical trials. In clinical practice they may be considered mainly for evaluating the presence and extent of crystal deposition, and structural changes that may impair function or functional outcomes, and also to monitor the response to urate-lowering therapy.

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Computed tomography images demonstrating extensive tophaceous deposits. Three-dimensional volume-rendered computed tomography images of the right foot from a patient with chronic gout, demonstrating extensive tophaceous deposits (visualized as red) – particularly at the first metatarsal phalangeal joint, midfoot and Achilles tendon. (a) Dorsal view and (b) lateral view.
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Figure 2: Computed tomography images demonstrating extensive tophaceous deposits. Three-dimensional volume-rendered computed tomography images of the right foot from a patient with chronic gout, demonstrating extensive tophaceous deposits (visualized as red) – particularly at the first metatarsal phalangeal joint, midfoot and Achilles tendon. (a) Dorsal view and (b) lateral view.

Mentions: CT allows excellent visualization of tophi (Figure 2). MSU crystals obtained from tophi measure around 170 Hounsfield units, and similar densities ranging from 150 to 200 Hounsfield units are measured in subcutaneous and intra-articular tophi [11]. Use of CT may assist in differentiating tophi from other subcutaneous nodules. Gerster and colleagues have suggested that CT provides more specific images than ultrasonography or magnetic resonance imaging (MRI) for assessment of tophi [12].


Imaging of gout: findings and utility.

Perez-Ruiz F, Dalbeth N, Urresola A, de Miguel E, Schlesinger N - Arthritis Res. Ther. (2009)

Computed tomography images demonstrating extensive tophaceous deposits. Three-dimensional volume-rendered computed tomography images of the right foot from a patient with chronic gout, demonstrating extensive tophaceous deposits (visualized as red) – particularly at the first metatarsal phalangeal joint, midfoot and Achilles tendon. (a) Dorsal view and (b) lateral view.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2714107&req=5

Figure 2: Computed tomography images demonstrating extensive tophaceous deposits. Three-dimensional volume-rendered computed tomography images of the right foot from a patient with chronic gout, demonstrating extensive tophaceous deposits (visualized as red) – particularly at the first metatarsal phalangeal joint, midfoot and Achilles tendon. (a) Dorsal view and (b) lateral view.
Mentions: CT allows excellent visualization of tophi (Figure 2). MSU crystals obtained from tophi measure around 170 Hounsfield units, and similar densities ranging from 150 to 200 Hounsfield units are measured in subcutaneous and intra-articular tophi [11]. Use of CT may assist in differentiating tophi from other subcutaneous nodules. Gerster and colleagues have suggested that CT provides more specific images than ultrasonography or magnetic resonance imaging (MRI) for assessment of tophi [12].

Bottom Line: Computed tomography may best evaluate bone changes, whereas magnetic resonance imaging is suitable to evaluate soft tissues, synovial membrane thickness, and inflammatory changes.Ultrasonography is a tool that may be used in the clinical setting, allowing evaluation of cartilage, soft tissues, urate crystal deposition, and synovial membrane inflammation.Also ultrasound-guided puncture may be useful for obtaining samples for crystal observation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Rheumatology Division, Hospital de Cruces, Baracaldo, Vizcaya, Spain. fernando.perezruiz@osakidetza.net

ABSTRACT
Imaging is a helpful tool for clinicians to evaluate diseases that induce chronic joint inflammation. Chronic gout is associated with changes in joint structures that may be evaluated with diverse imaging techniques. Plain radiographs show typical changes only in advanced chronic gout. Computed tomography may best evaluate bone changes, whereas magnetic resonance imaging is suitable to evaluate soft tissues, synovial membrane thickness, and inflammatory changes. Ultrasonography is a tool that may be used in the clinical setting, allowing evaluation of cartilage, soft tissues, urate crystal deposition, and synovial membrane inflammation. Also ultrasound-guided puncture may be useful for obtaining samples for crystal observation. Any of these techniques deserve some consideration for feasibility and implementation both in clinical practice and as outcome measures for clinical trials. In clinical practice they may be considered mainly for evaluating the presence and extent of crystal deposition, and structural changes that may impair function or functional outcomes, and also to monitor the response to urate-lowering therapy.

Show MeSH
Related in: MedlinePlus