eMedicine Specialties > Radiology > Musculoskeletal

Gout: Imaging

Author: Christopher D Smelser, DO, Staff Physician, Department of Radiology, William Beaumont Army Medical Center
Coauthor(s): Robert D Stoffey, DO, Director of Women's Imaging, Department of Radiology, Chief of Mammography Section, William Beaumont Army Medical Center; Amilcare Gentili, MD, Professor of Clinical Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital; Chief of Radiology, San Diego VA Health Care System
Contributor Information and Disclosures

Updated: Aug 27, 2009

Radiography


Radiograph of the foot in a patient with chronic ...

Radiograph of the foot in a patient with chronic gout. Podagra, or first metatarsophalangeal joint pain, can easily be understood when this radiograph is evaluated. Sclerosis and joint-space narrowing are seen in the first metatarsophalangeal joint, as well as in the fourth interphalangeal joint. Image courtesy of Larry Brent, MD.

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Radiograph of the foot in a patient with chronic ...

Radiograph of the foot in a patient with chronic gout. Podagra, or first metatarsophalangeal joint pain, can easily be understood when this radiograph is evaluated. Sclerosis and joint-space narrowing are seen in the first metatarsophalangeal joint, as well as in the fourth interphalangeal joint. Image courtesy of Larry Brent, MD.


Findings

In the early phase of gout, the clinical findings are limited to the soft tissues, of which an asymmetric swelling around the affected joint is typical. Another finding that may be evident is edema of the soft tissues around the joints. In a patient who has had multiple episodes of gouty arthritis in the same joint, a cloudy area of increased opacity may be seen on plain-film radiographs (see Image 2).

Radiograph of the hand. On this image of chronic ...

Radiograph of the hand. On this image of chronic tophaceous gouty arthritis, extensive bony erosions are noted throughout the carpal bones. Urate depositions may be present in the periarticular areas. Image courtesy of Larry Brent, MD.

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Radiograph of the hand. On this image of chronic ...

Radiograph of the hand. On this image of chronic tophaceous gouty arthritis, extensive bony erosions are noted throughout the carpal bones. Urate depositions may be present in the periarticular areas. Image courtesy of Larry Brent, MD.

In the intermediate phase of gout, the earliest bony changes appear, most commonly appearing initially in the first metatarsophalangeal joint area. These changes generally appear outside the joint or are in the juxta-articular area and are often described as punched-out lesions. Such lesions can progress to become sclerotic as they increase in size. In severe cases of intermediate-phase gout, fractures may be present in the affected areas.

In late-phase gout, the hallmark findings are numerous interosseous tophi. Another change that is evident on plain-film radiographs is joint-space narrowing, which can be severe and symptomatic. Marked deformities and subluxation may also be noted in affected areas, as well as calcium deposits in the soft tissues.

Computed Tomography

Findings

CT scanning can be used to study the effects of gout in areas that are hard to visualize with plain-film radiography.

Magnetic Resonance Imaging

Findings

The use of MRI in the radiologic examination of gout has not been extensively studied. However, this modality has excellent potential in the future study of gout.

Ultrasonography

Findings

The use of ultrasound in the diagnosis of gout has not been extensively studied. In a study by Perez-Ruiz et al, the ultrasound measurement of tophi appeared to be useful as an outcome measure for chronic gout.11 However, the authors caution that further randomized trials should be conducted.

Nuclear Imaging

Findings

Nuclear medicine studies can be used as a tool to measure the extent of gouty arthritis and to confirm clinically suspected disease.9 Characteristic findings include increased activity in the affected areas in all phases of a triple-phase bone scan.

More on Gout

Overview: Gout
Imaging: Gout
Follow-up: Gout
Multimedia: Gout
References
Further Reading
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References

  1. Dambro MR, ed. Griffith's 5-Minute Clinical Consult: A Reference for Clinicians. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001.

  2. Resnick D. Diagnosis of Bone and Joint Disorders. Vol 3. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1995:1511-39.

  3. Cotran RS, Robbins SL, Kumar V, Schoen FJ, eds. Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, Pa: WB Saunders Co; 1994:1255-8.

  4. Dalbeth N, McQueen FM. Use of imaging to evaluate gout and other crystal deposition disorders. Curr Opin Rheumatol. Mar 2009;21(2):124-31. [Medline].

  5. Perez-Ruiz F, Dalbeth N, Urresola A, de Miguel E, Schlesinger N. Gout. Imaging of gout: findings and utility. Arthritis Res Ther. 2009;11(3):232. [Medline].

  6. Choi HK, Al-Arfaj A, Eftekhari A, Munk PL, Shojania K, Reid G, et al. Dual Energy Computed Tomography in tophaceous gout. Ann Rheum Dis. Dec 9 2008;[Medline].

  7. Rettenbacher T, Ennemoser S, Weirich H, Ulmer H, Hartig F, Klotz W, et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. Eur Radiol. Mar 2008;18(3):621-30. [Medline].

  8. Dalbeth N, Clark B, Gregory K, Gamble G, Sheehan T, Doyle A, et al. Mechanisms of bone erosion in gout: a quantitative analysis using plain radiography and computed tomography. Ann Rheum Dis. Aug 2009;68(8):1290-5. [Medline].

  9. Tavaras JM, Ferrucci JT Jr, eds. Radiology: Diagnosis, Imaging, Intervention. Philadelphia, Pa: JB Lippincott Co; 1993.

  10. Coombs RJ, Pinsky ST, Padanilam TG. Bone scan findings of combined gout and septic arthritis in the same digit. Clin Nucl Med. May 2001;26(5):442-3. [Medline].

  11. Perez-Ruiz F, Martin I, Canteli B. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J Rheumatol. Sep 2007;34(9):1888-93. [Medline].

  12. Gentili A. The advanced imaging of gouty tophi. Curr Rheumatol Rep. Jun 2006;8(3):231-5. [Medline].

  13. Perez-Ruiz F, Naredo E. Imaging modalities and monitoring measures of gout. Curr Opin Rheumatol. Mar 2007;19(2):128-33. [Medline].

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Further Reading

Related eMedicine topics

Gout and Pseudogout

Gout (Ophthalmology)

Gout (Orthopedic Surgery)

Gout (Rheumatology)

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Keywords

peripheral arthritis, sodium urate crystals, podagra, hyperuricemia, primary gout, secondary gout, intermediate gout, late-phase gout, pseudogout, tophi, gouty nephropathy, gouty arthritis, first metatarsophalangeal joint pain, probenecid, colchicine, allopurinol, indomethacin

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Contributor Information and Disclosures

Author

Christopher D Smelser, DO, Staff Physician, Department of Radiology, William Beaumont Army Medical Center
Christopher D Smelser, DO is a member of the following medical societies: American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert D Stoffey, DO, Director of Women's Imaging, Department of Radiology, Chief of Mammography Section, William Beaumont Army Medical Center
Robert D Stoffey, DO is a member of the following medical societies: American College of Radiology, American Medical Association, American Osteopathic Association, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Amilcare Gentili, MD, Professor of Clinical Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital; Chief of Radiology, San Diego VA Health Care System
Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Medical Editor

Giuseppe Guglielmi, MD, Associate Professor of Radiology, Department of Radiology, Scientific Institute Hospital
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Lynne S Steinbach, MD, Chief of Musculoskeletal Radiology, Professor, Department of Radiology, University of California at San Francisco
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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