Background Gouty arthritis-causing uric acid is persistently in excess in the form of tophi. The ultimate therapeutic ideal should be to completely eliminate all tophi. So far, clinicians have relied on physical examination and plain radiographs to assess the locations and sizes of Gouty tophi. The dual energy computerized tomography (DECT), magnetic resonance imaging (MRI), 2-fluoro-deoxy-D-glucose (FDG) positron emission tomography (PET) each offers a different perspective of gouty tophi. None of the papers have used all four techniques concomitantly, no guidelines are available concerning their applications.
Objectives To visualize in a gout patient,using four different imaging techniques,the locations, sizes, compactness of tophi.
Methods The feet and knees were imaged by X-ray, MRI, DECT and PET.
Results DECT uncovered deposits in unexpected locations. The combination of DECT, MRI and PET showed that tophi were much larger and more inflammatory than clinically suspected.
Conclusions The locations and sizes of tophi in chronic gout patients can far exceed those accessible by physical examination and X-ray. These can be critical when making decisions concerning the initiation and aggressiveness of serum uric acid- lowering therapies.
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Disclosure of Interest None Declared
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