Advertisement

European Radiology

, Volume 18, Issue 3, pp 621–630 | Cite as

Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray

  • Thomas Rettenbacher
  • Sybille Ennemoser
  • Harald Weirich
  • Hanno Ulmer
  • Frank Hartig
  • Werner Klotz
  • Manfred Herold
Musculoskeletal

Abstract

The aim was to compare X-ray and ultrasound (US) in diagnosing gout. In a prospective study, 105 consecutive patients with clinical suspicion of gout underwent conventional X-ray und high-resolution US in order to help in arriving at a definite diagnosis. X-ray findings suggestive of gout included soft-tissue opacifications with densities between soft tissue and bone, articular and periarticular bone erosions, and osteophytes at the margins of opacifications or erosions. US findings suggestive of gout included bright stippled foci and hyperechoic soft-tissue areas. Fifty-five patients had a definite diagnosis of gout (102 involved sites), 31 patients were diagnosed as having another disease (59 involved sites), and 19 patients were excluded from the study because a definite diagnosis could not be established. X-ray suggested gout with a sensitivity of 31% (32/102) and a specificity of 93% (55/59), whereas US suggested gout with a sensitivity of 96% (98/102) and a specificity of 73% (43/59). US was much more sensitive than conventional X-ray but less specific. Our data show that US often provided additional diagnostic information in patients with clinical suspicion of gout when laboratory findings and X-ray results were negative or inconclusive and should therefore be used in these cases.

Keywords

Gout Tophi Ultrasound Plain X-ray Radiography 

References

  1. 1.
    Watt I (1997) Basic differential diagnosis of arthritis. Eur Radiol 7:344–351PubMedCrossRefGoogle Scholar
  2. 2.
    Terkeltaub RA (2003) Gout. N Engl J Med 349:1647–1655PubMedCrossRefGoogle Scholar
  3. 3.
    Gentili A (2006) The advanced imaging of gouty tophi. Curr Rheumatol Rep 8:231–235PubMedCrossRefGoogle Scholar
  4. 4.
    Feydy A, Liote F, Carlier R, Chevrot A, Drape JL (2006) Cervical spine and crystal-associated diseases: imaging findings. Eur Radiol 16:459–468PubMedCrossRefGoogle Scholar
  5. 5.
    Monu JU, Pope TL Jr (2004) Gout: a clinical and radiologic review. Radiol Clin North Am 42:169–184PubMedCrossRefGoogle Scholar
  6. 6.
    Bloch C, Hermann G, Yu TF (1980) A radiologic reevaluation of gout: a study of 2,000 patients. AJR Am J Roentgenol 134:781–787PubMedGoogle Scholar
  7. 7.
    Grassi W, Filippucci E, Farina A, Cervini C (2000) Sonographic imaging of the distal phalanx. Semin Arthritis Rheum 29:379–384PubMedCrossRefGoogle Scholar
  8. 8.
    Lyburn ID, Torreggiani WC, Harris AC, Zwirewich CV, Munk PL (2002) Tophaceous podagra: ultrasound diagnosis. Hosp Med 63:48–49PubMedGoogle Scholar
  9. 9.
    Gerster JC, Landry M, Dufresne L, Meuwly JY (2002) Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis 61:52–54PubMedCrossRefGoogle Scholar
  10. 10.
    Falasca GF (2006) Metabolic diseases: gout. Clinics? Dermatol 24:498–508Google Scholar
  11. 11.
    Balbir-Gurman A, Nahir AM, Braun-Moscovici Y, Soudack M (2005) Sonographic features of a tophaceous nodule. Isr Med Assoc J 7:746–747PubMedGoogle Scholar
  12. 12.
    Nalbant S, Corominas H, Hsu B, Chen LX, Schumacher RH, Kitumnuaypong T (2003) Ultrasonography for assessment of subcutaneous nodules. J Rheumatol 30:1191–1195PubMedGoogle Scholar
  13. 13.
    O’Leary ST, Goldberg JA, Walsh WR (2003) Tophaceous gout of the rotator cuff: a case report. J Shoulder Elbow Surg 12:200–201PubMedCrossRefGoogle Scholar
  14. 14.
    Wakefield RJ, Emery P, Pease C (2003) Gout related upper limb cellulitis: an ultrasound study. J Rheumatol 30:417–419PubMedGoogle Scholar
  15. 15.
    Grassi W, Meenagh G, Pascual E, Filippucci E (2006) “Crystal clear”—Sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin Arthritis Rheum 36:197–202PubMedCrossRefGoogle Scholar
  16. 16.
    Wright SA, Filippucci E, McVeigh C, Grey A, McCarron M, Grassi W, Wright GD, Taggart AJ (2007) High-resolution ultrasonography of the 1st metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis 66:859–864PubMedCrossRefGoogle Scholar
  17. 17.
    Ho CF, Chiou HJ, Chou YH, Chang CY (2003) Peritendinous lesions: the role of high-resolution ultrasonography. J Clin Imag 27:239–250CrossRefGoogle Scholar
  18. 18.
    Coombs PR, Houseman N, White R (2006) Chronic tophaceous gout of the third flexor digitorum profundus tendon in the hand: An unusual sonography diagnosis. AJR Am J Roentgenol 187:313–315CrossRefGoogle Scholar
  19. 19.
    Farina A, Filippucci E, Grassi W (2002) Sonographic findings of the synovial fluid. Reumatismo 54:261–265PubMedGoogle Scholar
  20. 20.
    van der Jagt EJ, Hofman S, Kraft BM, van Leeuwen MA (2000) Can we see enough? A comparative study of film-screen vs digital radiographs in small lesions in rheumatoid arthritis. Eur Radiol 10:304–307PubMedCrossRefGoogle Scholar
  21. 21.
    Sammak B, Abd El Bagi M, Al Shahed M, Hamilton D, Al Nabulsi J, Youssef B, Al Thagafi M (1999) Osteomyelitis: a review of currently used imaging techniques. Eur Radiol 9:894–900PubMedCrossRefGoogle Scholar
  22. 22.
    Watt I, Middlemiss H (1975) The radiology of gout. Clin Radiol 26:27–36PubMedCrossRefGoogle Scholar
  23. 23.
    Brailsford JF (1959) The radiology of gout. Br J Radiol 32:472–478PubMedCrossRefGoogle Scholar
  24. 24.
    Berens DL (1978) Roentgenographic changes in gout. Postgrad Med 63:154–161PubMedGoogle Scholar
  25. 25.
    Resnick D (1977) The radiologic manifestations of gouty arthritis. Clin Rev Diagn Imaging 9:265–335Google Scholar
  26. 26.
    Huber N (1896) Zur Verwerthung der Roentgen-Strahlen im Gebiete der inneren Medicin [The use of X-rays in internal medicine]. Dtsch Med Wochenschr 22:182–184CrossRefGoogle Scholar
  27. 27.
    Martel W (1968) The overhanging margin of bone: a roentgenologic manifestation of gout. Radiology 91:755–756PubMedGoogle Scholar
  28. 28.
    Gerster JC, Landry M, Rappoport G, Rivier G, Duvoisin B, Schnyder P (1996) Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis 55:921–923PubMedCrossRefGoogle Scholar
  29. 29.
    Lin J, Jacobson JA, Fessel DP, Weadock WJ (2000) An illustrated tutorial of musculoskeletal sonography. AJR Am J Roentgenol 175:1711–1719PubMedGoogle Scholar
  30. 30.
    Kane D, Grassi W, Sturrock R (2004) Musculoskeletal ultrasound—a state of the art review in rheumatology. Part 2: Clinical indications for musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 43:829–838CrossRefGoogle Scholar
  31. 31.
    Horcajadas AB, Lafuente JL, de la Cruz Burgos R, Muniz SH, Roca SA, Ortega SG, Franjo PD, Cruz EO (2003) Ultrasound and MR findings in tumor and tumor-like lesions of the fingers. Eur Radiol 13:672–685PubMedGoogle Scholar
  32. 32.
    Magarelli N, Guglielmi G, Di Matteo L, Tartaro A, Mattei PA, Bonomo L (2001) Diagnostic utility of an echo-contrast agent in patients with synovitis using power Doppler ultrasound: a preliminary study with comparison to contrast-enhanced MRI. Eur Radiol 11:1039–1046PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2007

Authors and Affiliations

  • Thomas Rettenbacher
    • 1
  • Sybille Ennemoser
    • 1
  • Harald Weirich
    • 1
  • Hanno Ulmer
    • 3
  • Frank Hartig
    • 2
  • Werner Klotz
    • 2
  • Manfred Herold
    • 2
  1. 1.Department of RadiologyInnsbruck Medical UniversityInnsbruckAustria
  2. 2.Department of Internal MedicineInnsbruck Medical UniversityInnsbruckAustria
  3. 3.Department of Medical Statistics, Informatics, and Health EconomicsInnsbruck Medical UniversityInnsbruckAustria

Personalised recommendations