Current status of ultrasound and dual-energy computed tomography in the evaluation of gout


Gout is the most common inflammatory arthritis and is increasing in relevance due to its rising prevalence and incidence. Dual-energy CT (DECT) and ultrasound (US) are the most frequently used imaging modalities for the diagnosis of gout and for the follow-up of patients receiving therapy. Although DECT has the highest diagnostic accuracy for gout and shows consistently excellent reader agreement in the assessment of urate deposition change after therapy, US also performs well and remains just as important an imaging tool in these realms due to its practical advantages in cost, availability, and safety. This article reports the current status of these two modalities in regard to diagnosis and therapy follow-up.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Kuo CF, Grainge MJ, Zhang W, Doherty M (2015) Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 11:649–62

    Article  Google Scholar 

  2. 2.

    Minichiello E, Semerano L, Boissier MC (2016) Time trends in the incidence, prevalence, and severity of rheumatoid arthritis: a systematic literature review. Joint Bone Spine 83(6):625–630

    Article  Google Scholar 

  3. 3.

    Newberry SJ, FitzGerald JD, Motala A et al (2017) Diagnosis of gout: a systematic review in support of an American College of Physicians Clinical Practice Guideline. Ann Intern Med 166(1):27–36

    Article  Google Scholar 

  4. 4.

    Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D et al (2015) 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 67:2557–2568

    Article  Google Scholar 

  5. 5.

    Grainger R, Dalbeth N, Keen H, Durcan L, Lawrence Edwards N, Perez-Ruiz F et al (2015) Imaging as an outcome measure in gout studies: report from the OMERACT Gout Working Group. J Rheumatol 42:2460–2464

    Article  Google Scholar 

  6. 6.

    Dalbeth N, Doyle AJ (2018) Imaging tools to measure treatment response in gout. Rheumatology (Oxford) 57(suppl_1):i27–i34

    Article  Google Scholar 

  7. 7.

    Gruber M, Bodner G, Rath E, Supp G, Weber M, Schueller-Weidekamm C (2015) Dual-energy computed tomography compared with ultrasound in the diagnosis of gout. Rheumatol Oxf Engl 53(1):173–179

    Article  Google Scholar 

  8. 8.

    Zhu L, Wu H, Wu X, Sun W, Zhang T, Ye L, Wang W, Wang J (2015) Comparison between dual-energy computed tomography and ultrasound in the diagnosis of gout of various joints. Acad Radiol 22(12):1497–1502

    Article  Google Scholar 

  9. 9.

    Ogdie A, Taylor WJ, Weatherall M, Fransen J, Jansen TL, Neogi T, Schumacher HR, Dalbeth N (2015) Imaging modalities for the classification of gout: systematic literature review and meta-analysis. Ann Rheum Dis 74(10):1868–1874

    Article  Google Scholar 

  10. 10.

    Huppertz A, Hermann KG, Diekhoff T, Wagner M, Hamm B, Schmidt WA (2014) Systemic staging for urate crystal deposits with dual-energy CT and ultrasound in patients with suspected gout. Rheumatol Int 34(6):763–771

    CAS  Article  Google Scholar 

  11. 11.

    Lee YH, Song GG (2017) Diagnostic accuracy of dual-energy computed tomography in patients with gout: a meta-analysis. Semin Arthritis Rheum 47:95–101

    Article  Google Scholar 

  12. 12.

    Lee YH, Song GG (2017) Diagnostic accuracy of ultrasound in patients with gout: a meta-analysis. Semin Arthritis Rheum. (Epub ahead of print)

    Article  PubMed  Google Scholar 

  13. 13.

    Wu H, Xue J, Ye L, Zhou Q, Shi D, Xu R (2014) The application of dual-energy computed tomography in the diagnosis of acute gouty arthritis. Clin Rheumatol 33(7):975–979

    Article  Google Scholar 

  14. 14.

    Bongartz T, Glazebrook KN, Kavros SJ et al (2015) Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. Ann Rheum Dis 74:1072–1077

    CAS  Article  Google Scholar 

  15. 15.

    Jia E, Zhu J, Huang W, Chen X, Li J (2018) Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout. Clin Rheumatol 37(3):773–777

    Article  Google Scholar 

  16. 16.

    Araujo EG, Bayat S, Petsch C, Englbrecht M, Faustini F, Kleyer A et al (2015) Tophus resolution with pegloticase: a prospective dual-energy CT study. RMD Open 1:e000075

    Article  Google Scholar 

  17. 17.

    Bayat S, Aati O, Rech J, Sapsford M, Cavallaro A, Lell M, Araujo E, Petsch C, Stamp LK, Schett G, Manger B, Dalbeth N (2016) Development of a dual-energy computed tomography scoring system for measurement of urate deposition in gout. Arthritis Care Res 68(6):769–775

    Article  Google Scholar 

  18. 18.

    Sun Y, Chen H, Zhang Z, Ma L, Zhou J, Zhou Y, Ding Y, Jin X, Jiang L (2015) Dual-energy computed tomography for monitoring the effect of urate-lowering therapy in gouty arthritis. Int J Rheum Dis 18(8):880–885

    CAS  Article  Google Scholar 

  19. 19.

    Rajan A, Aati O, Kalluru R, Gamble GD, Horne A, Doyle AJ, McQueen FM, Dalbeth N (2013) Lack of change in urate deposition by dual-energy computed tomography among clinically stable patients with long-standing tophaceous gout: a prospective longitudinal study. Arthritis Res Ther 15(5):R160

    Article  Google Scholar 

  20. 20.

    Metzger SC, Koehm M, Wichmann JL, Buettner S, Scholtz JE, Beeres M et al (2016) Dual-energy CT in patients with suspected gouty arthritis: effects on treatment regimen and clinical outcome. Acad Radiol 23(3):267–272

    Article  Google Scholar 

  21. 21.

    Finkenstaedt T, Manoliou A, Toniolo M, Higashigaito K, Andreisek G, Guggenberger R, Michel B, Alkadhi H (2016) Gouty arthritis: the diagnostic and therapeutic impact of dual-energy CT. Eur Radiol 26(11):3989–3999

    Article  Google Scholar 

  22. 22.

    Gamala M, Linn-Rasker SP, Nix M, Heggelman BGF, van Laar JM, Pasker-de Jong PCM, Jacobs JWG, Klaasen R (2018) Gouty arthritis: decision-making following dual-energy CT scan in clinical practice, a retrospective analysis. Clin Rheumatol. (epub ahead of print)

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Ottaviania S, Gilla G, Aubruna A, Palazzoa E, Meyera O, Dieudéa P (2015) Ultrasound in gout: A useful tool for following urate-lowering therapy. Joint Bone Spine 82:42–44

    Article  Google Scholar 

  24. 24.

    Thiele RG, Schlesinger N (2010) Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int 30:495–503

    Article  Google Scholar 

  25. 25.

    Peiteado D, Villalba A, Martin-Mola E, Balsa A, De Miguel E (2017) Ultrasound sensitivity to changes in gout: a longitudinal study after two years of treatment. Clin Exp Rheumatol 35:746–751

    PubMed  Google Scholar 

  26. 26.

    Das S, Goswami RP, Ghosh A et al (2017) Temporal evolution of urate crystal deposition over articular cartilage after successful urate-lowering therapy in patients with gout: an ultrasonographic perspective. Mod Rheumatol 27:518–523

    CAS  Article  Google Scholar 

  27. 27.

    Pascart T, Grandjean A, Norberciak L, Ducoulombier V, Motte M, Luraschi H et al (2017) Ultrasonography and dual-energy computed tomography provide different quantification of urate burden in gout: results from a cross-sectional study. Arthritis Res Ther 19:171

    Article  Google Scholar 

  28. 28.

    Modjinou DV, Krasnokutsky S, Gyftopoulos S, Pike VC, Karis E, Keenan RT et al (2017) Comparison of dual-energy CT, ultrasound and surface measurement for assessing tophus dissolution during rapid urate debulking. Clin Rheumatol 36:2101–2107

    Article  Google Scholar 

  29. 29.

    Ramon A, Bohm-Sigrand A, Pottecher P, Richette P, Maillefert JF, Devilliers H, Ornetti P (2018) Role of dual-energy CT in the diagnosis and follow-up of gout: systematic analysis of the literature. Clin Rheumatol 37(3):587–595

    Article  Google Scholar 

  30. 30.

    Peiteado D, Villalba A, Martin-Mola E, de Miguel E (2015) Reduction but not disappearance of Doppler signal after two years of treatment for gout. Do we need a more intensive treatment? Clin Exp Rheumatol 33:385–390

    PubMed  Google Scholar 

  31. 31.

    Choi HK, Burns LC, Shojania K, Koenig N, Reid G, Abufayyah M, Law G, Kydd AS, Ouellette H, Nicolaou S (2012) Dual energy CT in gout: a prospective validation study. Ann Rheum Dis 71(9):1466–1471

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Hillary W. Garner.

Ethics declarations

Conflict of interest

Hillary W. Garner, M.D. and Daniel E. Wessell, M.D., Ph.D. declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Garner, H.W., Wessell, D.E. Current status of ultrasound and dual-energy computed tomography in the evaluation of gout. Rheumatol Int 38, 1339–1344 (2018).

Download citation


  • Gout
  • Imaging
  • Dual energy
  • Computed tomography
  • Ultrasound