Background The presence of tophi is associated with impairment of health-related quality of life as well as increase in prevalence of comorbidities in patients with gout.
Objectives The purpose of our study was to evaluate the utility of dual-energy CT (DECT) in detecting subclinical tophi in patients with gouty arthritis.
Methods Paired plain radiographs and DECT scans of foot joints in 6 patients with gout who had prior history of acute gouty arthritis in joints of foot without clinical tophi were evaluated for the presence of subclinical tophi. Foot joints included 22 metatarsophalangeal (MTP), interphalangeal, tarsometatarsal, cuboid metatarsal, talonavicular, calcaneocuboid, and subtalar joints on each foot. If present, total volumes of tophi in both feet were quantified using an automated software program of DECT.
Results Of 264 foot joint areas examined, tophi were detected in 24 joints (9.1%) by DECT, whereas no tophi were detected by plain radiographs. The mean total volume of tophi per patient was 0.77±0.71cm3, and mean 4.0±2.8 joint areas per patient were positive for tophi detected by DECT. Most common site for tophi was 1st MTP (45.8%). Four patients had tophi detected in asymptomatic joints.
Conclusions DECT has excellent detection of subclinical tophi in gout patients who had no apparent tophi on physical examination. DECT is a promising tool for accurate and early detection of tophi in a noninvasive manner.
Choi HK, Al-Arfaj AM, Eftekhari A, et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis 2009;68:1609–12.
Disclosure of Interest None declared