A Case of Spinal Infectious Osteomyelitis Versus Gout: Advanced Imaging with Dual Energy CT
Kimberly D Seifert1, Vahe M Zohrabian2, Ichiro Ikuta3
1Department of Radiology, Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, CA, USA.
The Yale Journal of Biology and Medicine
|December 31, 2021
Summary
Dual energy CT can detect monosodium urate crystals in spinal discs, offering a noninvasive method for diagnosing gout in unusual locations. This technique aids in evaluating spinal involvement of gout, especially in patients with high uric acid levels.
Area of Science:
- Radiology
- Rheumatology
- Orthopedics
Background:
- Spinal involvement of gout is uncommon and challenging to diagnose noninvasively.
- Discitis and osteomyelitis are common differential diagnoses for back pain with radiculopathy.
Observation:
- A patient with back pain and radiculopathy developed knee effusion with urate crystals.
- Magnetic resonance imaging (MRI) suggested discitis/osteomyelitis at L4-L5.
- Dual-energy CT (DECT) of the lumbar spine was performed.
Findings:
- DECT revealed monosodium urate crystal deposition within the intervertebral discs at L4-L5.
- This confirmed spinal gout as the etiology for the patient's symptoms.
Implications:
- DECT offers a noninvasive method for diagnosing gout in spinal locations, potentially replacing invasive biopsies.
- DECT should be considered in patients with elevated serum uric acid and suspected spinal gout.
- This technique can aid in evaluating gout in atypical or difficult-to-sample locations.
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