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.
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References
Watt I (1997) Basic differential diagnosis of arthritis. Eur Radiol 7:344–351
Terkeltaub RA (2003) Gout. N Engl J Med 349:1647–1655
Gentili A (2006) The advanced imaging of gouty tophi. Curr Rheumatol Rep 8:231–235
Feydy A, Liote F, Carlier R, Chevrot A, Drape JL (2006) Cervical spine and crystal-associated diseases: imaging findings. Eur Radiol 16:459–468
Monu JU, Pope TL Jr (2004) Gout: a clinical and radiologic review. Radiol Clin North Am 42:169–184
Bloch C, Hermann G, Yu TF (1980) A radiologic reevaluation of gout: a study of 2,000 patients. AJR Am J Roentgenol 134:781–787
Grassi W, Filippucci E, Farina A, Cervini C (2000) Sonographic imaging of the distal phalanx. Semin Arthritis Rheum 29:379–384
Lyburn ID, Torreggiani WC, Harris AC, Zwirewich CV, Munk PL (2002) Tophaceous podagra: ultrasound diagnosis. Hosp Med 63:48–49
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 61:52–54
Falasca GF (2006) Metabolic diseases: gout. Clinics? Dermatol 24:498–508
Balbir-Gurman A, Nahir AM, Braun-Moscovici Y, Soudack M (2005) Sonographic features of a tophaceous nodule. Isr Med Assoc J 7:746–747
Nalbant S, Corominas H, Hsu B, Chen LX, Schumacher RH, Kitumnuaypong T (2003) Ultrasonography for assessment of subcutaneous nodules. J Rheumatol 30:1191–1195
O’Leary ST, Goldberg JA, Walsh WR (2003) Tophaceous gout of the rotator cuff: a case report. J Shoulder Elbow Surg 12:200–201
Wakefield RJ, Emery P, Pease C (2003) Gout related upper limb cellulitis: an ultrasound study. J Rheumatol 30:417–419
Grassi W, Meenagh G, Pascual E, Filippucci E (2006) “Crystal clear”—Sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin Arthritis Rheum 36:197–202
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 66:859–864
Ho CF, Chiou HJ, Chou YH, Chang CY (2003) Peritendinous lesions: the role of high-resolution ultrasonography. J Clin Imag 27:239–250
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 187:313–315
Farina A, Filippucci E, Grassi W (2002) Sonographic findings of the synovial fluid. Reumatismo 54:261–265
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 10:304–307
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 9:894–900
Watt I, Middlemiss H (1975) The radiology of gout. Clin Radiol 26:27–36
Brailsford JF (1959) The radiology of gout. Br J Radiol 32:472–478
Berens DL (1978) Roentgenographic changes in gout. Postgrad Med 63:154–161
Resnick D (1977) The radiologic manifestations of gouty arthritis. Clin Rev Diagn Imaging 9:265–335
Huber N (1896) Zur Verwerthung der Roentgen-Strahlen im Gebiete der inneren Medicin [The use of X-rays in internal medicine]. Dtsch Med Wochenschr 22:182–184
Martel W (1968) The overhanging margin of bone: a roentgenologic manifestation of gout. Radiology 91:755–756
Gerster JC, Landry M, Rappoport G, Rivier G, Duvoisin B, Schnyder P (1996) Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis 55:921–923
Lin J, Jacobson JA, Fessel DP, Weadock WJ (2000) An illustrated tutorial of musculoskeletal sonography. AJR Am J Roentgenol 175:1711–1719
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) 43:829–838
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 13:672–685
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 11:1039–1046
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Rettenbacher, T., Ennemoser, S., Weirich, H. et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. Eur Radiol 18, 621–630 (2008). https://doi.org/10.1007/s00330-007-0802-z
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DOI: https://doi.org/10.1007/s00330-007-0802-z