Imaging of gout: findings and pitfalls. A pictorial review

Gout is the most common crystal arthropathy, accounting for up to 5% of all arthritis. The hallmark of the disease is hyperuricemia with the subsequent deposition of monosodium urate (MSU) crystals in the intra- and extra-articular soft tissues and bones, leading to inflammation of these tissues. Recurrent intermittent flares can result in chronic gouty arthritis leading to cartilage and bone destruction. The most sensitive and specific imaging methods for diagnosing acute gout are ultrasound and dual energy computed tomography (DECT). In the chronic or tophaceous gout, imaging may depict tophi and their local destructive effect on surrounding tissues with characteristic findings on radiographs. In this pictorial review the imaging features of acute and chronic gout on radiographs, ultrasound, and DECT are presented, as well as imaging pitfalls that one needs to be aware.