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The gold standard for establishing the diagnosis of gouty arthritis is the detection of monosodium urate (MSU) crystals in synovial fluid or periarticular tophi. The European League Against Rheumatism recommendations from 2006 state that ‘for typical presentations of gout a clinical diagnosis alone is reasonably accurate but not definitive without crystal confirmation’.1 In addition, various imaging methods can help to non-invasively support the diagnosis of gout. Joint ultrasonography can detect MSU deposits at cartilaginous surfaces (‘double contour sign’) as well as periarticular tophus formation.2 3
Dual energy CT (DECT) is an imaging method that uses x-ray beams of two different energies to differentiate MSU deposits from connective tissues and from calcium containing structures by their absorption properties.4 Choi et al have demonstrated that in tophaceous gout, DECT …
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