Correlation of magnetic resonance imaging with clinical & radiological manifestations of tophaceous and non-tophaceous gout

Abstract EN

Although magnetic-resonance imaging (MRI), is not routinely used for evaluation of gout, however gout may present clinically in a confusing manner, and gouty tophi occasionally mimic an infectious or neoplastic process.

Objective : to determine the relative value of clinical examination, plain radiographs and MRI in evaluating the extent of uprate deposition, soft tissue and osseous destruction in gouty arthritis.

Methods : this study included 26 patients, who proved to have at least 6 of the published criteria for gouty arthritis.

Patients were divided into two groups: Group (A) : included 15 patients with no apparent tophi on physical examination, they were 3 females and 12 males, with mean age 51.3 years.

Group (B) : included 11 patients, with classic gouty tophi on physical examination, they were 2 females and 9 males, with mean age 55.2 years.

All patients underwent full clinical examination and measurement of serum urate concentrations.

Plain radiographs and MRI were also performed to all the involved joint areas of all patients.

Results : The prevalence of gout in males was 86.6 % and 81.8 % in both groups respectively.

The first MTP joint was involved in 72.2 % and 64.3 % in both groups respectively followed by the ankles, heels, knees, fingers and wrists.

Hyperuricemia was the most common accompanying abnormal laboratory test (61.5 %).

Characteristic radiographic punched-out bone erosions were found in 53.8% of all lesions.

MRI studies showed characteristic signal intensity and enhancement of soft tissues and interosseous lesions in both groups.

On T2 – weighted images, approximately two-thirds (72.7 %) of all lesions appeared as areas of increased signal intensity.

Multiple punctate, low signal areas in both TI and T2 -weighted images scattered throughout the tophaceous materials were demonstrated in 86.6% of all lesions.

Conclusion : Although radiographic changes are characteristics for gout and were corresponding to progression, severity and disease duration, however radiographic examination was not a sensitive method for the diagnosis of the disease.

MRI may be promising in the study of this disease, MRI detected early and subclinical tophaceous deposits.

It might be considered a useful method of determining the extent of the disease and may provide information regarding the patterns of deposition and spread of urate crystals.

Further studies are recommended in this situation.