How is CT scanning used in the diagnosis of gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Plain radiography and computed tomography (CT) are complementary for recognizing erosions in gout. [115] Dual-energy CT, using a renal stone color-coding protocol, assesses chemical composition, labeling urate deposits in red. [116] In a case report, Ward et al describe the use of dual-energy CT to diagnose tumoral calcium pyrophosphate crystal deposition, differentiating it from gouty tophus or soft-tissue malignancy. [117]

In a study comparing CT imaging versus a history of urinary tract calculus for identification of nephrolithiasis in gout patients, 62% of the patients with CT-documented scans had no history of urolithiasis. In 383 male patients with primary gout, CT scanning confirmed nephrolithiasis in 103 (26.9%), whereas the history of urinary tract calculus was positive in only 65 (17%). The authors concluded that the prevalence of urolithiasis cannot be accurately determined on the basis of patients’ histories. [118]

Stamp et al reported that multi-energy spectral photon counting computed tomography (SPCCT) was able to detect, differentiate, and quantify monosodium urate crystal deposits in a gouty finger ex vivo, as well as to specifically detect, identify, and quantify calcium pyrophosphate within an osteoarthritic meniscus, and distinguish them from hydroxyapatite crystal deposits. These authors propose that SPCCT has the potential to be useful in diagnosing crystal arthropathies. [119]  

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