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
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