Relevant imaging elements for gout diagnosis and treatment

Eloy De Avila Fernandes ,Samuel Brighenti Bergamaschi ,Tatiane Cantarelli Rodrigues ,Gustavo Coelho Dias ,Ralff Malmann ,Germano Martins Ramos ,Soraya Silveira Monteiro

doi:10.24294/irr.v5i1.1749

Home - IRR - Volume 5 - Issue 1

Submit to IRR

Journal Browser

Volume | Year

Issue

• Current lssue

View All

News and Announcements

Nov 8, 2024

World Radiography Day 8 November 2024 - Importance, Theme & History
Oct 22, 2024

Fourth Committee Considers Effects of Atomic Radiation, Reaffirms Commitment to UN Scientific Committee, Hears Reports on Information, Peacekeeping

View All

Relevant imaging elements for gout diagnosis and treatment

Eloy De Avila Fernandes

Samuel Brighenti Bergamaschi

Tatiane Cantarelli Rodrigues

Gustavo Coelho Dias

Ralff Malmann

Germano Martins Ramos

Soraya Silveira Monteiro

Imaging and Radiation Research 2022, 5(1), 68-77; https://doi.org/10.24294/irr.v5i1.1749

Submitted：01 Jan 1970

Accepted：01 Jan 1970

Published：01 Jan 1970

Download PDF(801.16KB)

XML

Abstract

Gout is an arthritis characterized by the deposition of sodium monoacid crystals in the synovial membrane, articular cartilage, and periarticular tissues that leads to an inﬂamatory process. In most cases, the diagnosis is established by clinical criteria and analysis of the synovial fluid for MSU crystals. However, gout may manifest in atypical ways and make diagnosis difficult. In these situations, imaging studies play a fundamental role in helping to confirm the diagnosis or even exclude other differential diagnoses. Conventional radiography is still the most commonly used method in the follow-up of these patients, but it is a very insensitive test, because it only detects late changes. In recent years, advances in imaging methods have emerged in relation to gout. Ultrasound has proven to be a highly accurate test in the diagnosis of gout, identifying MSU deposits in articular cartilage and periarticular tissues, and detecting and characterizing tophi, tendinopathies, and tophi enthesopathies. Computed tomography is an excellent exam for the detection of bone erosions and evaluation of spinal involvement. Dual-energy computed tomography, a new method that provides information on the chemical composition of tissues, allows identification of MSU deposits with high accuracy. MRI can be useful in the evaluation of deep tissues not accessible by ultrasound. In addition to diagnosis, with the emergence of drugs that aim to reduce the tophaceous burden, imaging examinations become a useful tool in the follow-up treatment of gout patients.

Keywords

References

Chen CKH, Yeh LR, Pan HB, et al. Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients. Skeletal Radiology 1999; 28(2): 75–80.

Smith EUR, Diaz-Torne C, Perez-Ruiz F, et al. Epidemiology of gout: an update. Best Practice & Research Clinical Rheumatology 2010; 24(6): 811–827.

Malik A, Schumacher HR, Dinnella JE, et al. Clinical diagnostic criteria for gout: Comparsion with the gold standard of synovial fluid crystal analysis. JCR: Journal of Clinical Rheumatology 2009; 15(1): 22–24.

Monu JUV, Pope TL. Gout: A clinical and radiologic review. Radiologic Clinics 2004; 42(1): 169–184.

Desai MA, Peterson JJ, Garner HW, et al. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics 2011; 31(5): 1365–1375.

Helito PVP, De Mello FM, Fuller R, et al. Tomografia computadorizada de coluna em uma população com gota (Portuguese) [Spine computed tomography in a population with gout]. Tema livre JPR 2013.

Dungan DH, Seeger LL, Grant EG. Case report 707: Hemorrhagic Baker’s cyst of the right calf. Skeletal Radiology 1992; 21(1): 52–55.

Abrahamsson SO. Gouty tenosynovitis simulating an infection: A case report. Acta Orthopaedica Scandinavica 1987; 58(3): 282–283.

Perez-Ruiz F, Dalbeth N, Urresola A, et al. Gout. Imaging of gout: Findings and utility. Arthritis Research & Therapy 2009; 11(3): 1–8.

Nalbant S, Corominas H, Hsu B, et al. Ultrasonography for assessment of subcutaneous nodules. The Journal of Rheumatology 2003; 30(6): 1191–1195.

De Ávila Fernandes E, Kubota ES, Sandim GB, et al. Ultrasound features of tophi in chronic tophaceous gout. Skeletal Radiology 2011; 40(3): 309–315.

Dalbeth N, Schauer C, MacDonald P, et al. Methods of tophus assessment in clinical trials of chronic gout: A systematic literature review and pictorial reference guide. Annals of the Rheumatic Diseases 2011; 70(4): 597–604.

Dalbeth N, Clark B, Gregory K, et al. Mechanisms of bone erosion in gout: A quantitative analysis using plain radiography and computed tomography. Annals of the Rheumatic Diseases 2009; 68(8): 1290–1295.

Schumacher Jr HR, Becker MA, Edwards NL, et al. Magnetic resonance imaging in the quantitative assessment of gouty tophi. International Journal of Clinical Practice 2006; 60(4): 408–414.

Dalbeth N. Clinical applications of dual-energy computed tomography for rheumatology. The Rheumatologist 2014.

Bloch C, Hermann G, Yu TF. A radiologic reevaluation of gout: A study of 2,000 patients. American Journal of Roentgenology 1980; 134(4): 781–787.

Rettenbacher T, Ennemoser S, Weirich H, et al. Diagnostic imaging of gout: Comparison of high-resolution US versus conventional X-ray. European Radiology 2008; 18(3): 621–630.

Martel W. The overhanging margin of bone: A roentgenologic manifestation of gout. Radiology 1968; 91(4): 755–756.

Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford) 2007; 46(7): 1116–1121.

Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: An ultrasound-controlled study. Arthritis Research & Therapy 2011; 13(1): 1–7.

Balbir-Gurman A, Nahir AM, Braun-Moscovici Y, et al. Sonographic features of a tophaceous nodule. The Israel Medical Association Journal 2005; 7(11): 746–747.

Thiele RG, Schlesinger N. Ultrasound detects more erosions ingout than conventional radiography. Annals of the Rheumatic Diseases 2010; 69(Suppl. 3): 612.

Lai KL, Chiu YM. Role of ultrasonography in diagnosing gouty arthritis. Journal of Medical Ultrasound 2011; 19(1): 7–13.

Wright SA, Filippucci E, McVeigh C, et al. High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: A controlled study. Annals of the Rheumatic Diseases 2007; 66(7): 859–864.

de Ávila Fernandes E, Sandim GB, Mitraud SAV, et al. Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout. Insights Into Imaging 2010; 1(3): 143–148.

Lagoutaris ED, Adams HB, DiDomenico LA, et al. Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration. A case report. The Journal of Foot and Ankle Surgery 2005; 44(3): 222–224.

Grassi W, Meenagh G, Pascual E, et al. “Crystal clear”—Sonographic assessment of gout and calcium pyrophosphate deposition disease. Seminars in Arthritis and Rheumatism 2006; 36(3): 197–202.

Perez-Ruiz F, Martin I, Canteli B. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. The Journal of Rheumatology 2007; 34(9): 1888–1893.

Dalbeth N, Collis J, Gregory K, et al. Tophaceous joint disease strongly predicts hand function in patients with gout. Rheumatology 2007; 46(12): 1804–1807.

Dalbeth N, Clark B, Gregory K, et al. Computed tomography measurement of tophus volume: comparison with physical measurement. Arthritis Care & Research 2007; 57(3): 461–465.

Glazebrook KN, Guimarães LS, Murthy NS, et al. Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: Initial evaluation. Radiology 2011; 261(2): 516–524.

Nicolaou S, Yong-Hing CJ, Galea-Soler S, et al. Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. American Journal of Roentgenology 2010; 194(4): 1072–1078.

Choi HK, Burns LC, Shojania K, et al. Dual energy CT in gout: A prospective validation study. Annals of the Rheumatic Diseases 2012; 71(9): 1466–1471.

Gruber M, Bodner G, Rath E, et al. Dual-energy computed tomography compared with ultrasound in the diagnosis of gout. Rheumatology (Oxford) 2014; 53(1): 173–179.

Glazebrook KN, Kakar S, Ida CM, et al. False-negative dual-energy computed tomography in a patient with acute gout. Journal of Clinical Rheumatology 2012; 18(3): 138–141.

Manger B, Lell M, Wacker J, et al. Detection of periarticular urate deposits with dual energy CT in patients with acute gouty arthritis. Annals of the Rheumatic Diseases 2012; 71(3): 470–472.

Khoo JN, Tan SC. MR imaging of tophaceous gout revisited. Singapore Medical Journal 2011; 52(11): 840–846.

McQueen FM, Doyle A, Dalbeth N. Imaging in gout-What can we learn from MRI, CT, DECT and US? Arthritis Research & Therapy 2011; 13(6): 1–8.

Carter JD, Kedar RP, Anderson SR, et al. An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology 2009; 48(11): 1442–1446.

Previous
article in this issue

Next
article in this issue