Preliminary Diagnosis: Gout

I. What imaging technique is first-line for this diagnosis?

Plain radiographs

II. Describe the advantages and disadvantages of this technique for diagnosis of gout.

Advantages
  • Clearly visualizes dense gouty tophi and osseous erosions

  • Clearly visualizes overhanging cortical edges and juxtaarticular erosions extending perpendicularly from the underlying bone

Disadvantages
  • Radiographs often normal in the first 7 to 10 years of the disease

  • Decreased sensitivity for evaluating soft tissue, noncalcified gouty tophi

III. What are the contraindications for the first-line imaging technique?

  • Relative contraindication in pregnant patients

IV. What alternative imaging techniques are available?

  • MRI without contrast

  • Nuclear medicine triple phase bone scan

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of gout.

MRI
Advantages
  • MRI good for evaluation of joint effusion, synovial pannus, intraarticular/juxtaarticular erosion, soft tissue/bone marrow edema, and effectively characterize soft tissue/calcified gouty tophi

Disadvantages
  • Difficult to precisely evaluate osseous erosions and further disease manifestations; radiographs and CT are much better used to evaluate osseous subtle changes.

Nuclear medicine triple phase bone scan
Advantages
  • Sensitive in detecting areas of increased soft tissue blood flow and blood pool, and osseous hyperemia

Disadvantages
  • Not a very specific test and lacks anatomic detail as compared to CT and MR

VI. What are the contraindications for the alternative imaging techniques?

MRI
  • Individuals with cardiac pacemaker devices are other non-MR compatible devices

Nuclear medicine triple phase bone scan
  • No definite contraindications to nuclear medicine examination