Important features of imaging to be considered in diagnosis and managing gout
Gout can be defined as an inflammatory arthritis that is caused by the deposition of mono-sodium urate crystals (MSU) in the synovial membrane, articular cartilage and periarticular tissues. It has been found to be more prevalent in men. Clinical measures and synovial fluid investigation to explore MSU crystals are used for the diagnosis of gout. However, gout may occasionally have uncharacteristic features which make it difficult to diagnose. In such circumstances, imaging methods play a vital role in confirming the diagnosis of gout.
For assessing gout patients, traditional radio-graphs are still the usual methods to be used. In the recent years, there has been numerous advancements in imaging techniques used for the diagnosis of gout. Ultrasound has shown high precision in recognizing MSU deposits in the synovial membrane and articular cartilage, in discovering and describing tophi and in classifying tophaceous tendinopathy and enthesopathy. It also holds the capability to confirm crystal deposition in patients with articular pain in the absence of a classical gout crisis.
Computed tomography (CT) is an outstanding method for sensing bone erosion's and being valuable in spine involvement. The chemical arrangement of tissues, with high correctness in recognizing MSU deposits, even in the initial phase of the disease and in cases of complex presentations, dual‐energy CT has been found to be very much beneficial.
Magnetic resonance imaging (MRI) is suitable for evaluating deep tissues not reachable by ultrasound. In addition to diagnosis, with the advent of new medications that intend to reduce tophaceous burden, imaging techniques have become advantageous tools in monitoring the treatment of patients with gout.