How is MRI 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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MRI is not part of any routine evaluation for acute arthritis. MRI evidence of edema is minimal in gout, unless concomitant osteomyelitis is present. [120] However, MRI with gadolinium is recommended when tendon sheath involvement must be evaluated and when osteomyelitis is in the differential diagnosis. Large deposits of crystals may be seen in bursae or ligaments. MRI examination of erosions reveals tophi but no bone edema or synovitis. [121]

Tophi usually have low or intermediate signal intensity on T1-weighted spin echo images. Signal intensity also tends to be low on T2-weighted images. In the absence of inflammation, the tophi are sharply delineated. Presence of inflammation results in increased perilesional signal intensity. Tophi and the surrounding area of inflammation enhance with gadolinium. [122]

In a study of 10 cadaveric knees by Abreu et al, radiographic imaging and histologic analysis demonstrated widespread CPPD crystal deposition in four of the specimens (40%), while MRI demonstrated some calcifications only within the articular cartilage of the femoral condyles in three of those four specimens. In all four specimens, radiographs and histologic analysis had higher sensitivity than MRI. [123]

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