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Spinal gout in gouty polyarthropathy.

Karel Mercken1, Bjorn Valgaeren2, Nathalie Noppe2

  • 1Department of Radiology, University Hospitals Leuven, Leuven, Belgium. mercken.karel@skynet.be.

Skeletal Radiology
|July 13, 2025
PubMed
Summary

Spinal gout, a common cause of inflammatory arthritis, is often under-recognized. Dual-energy CT (DECT) effectively diagnoses spinal gout, even after prior surgery, by detecting urate crystals.

Keywords:
ArthropathyDual energy CTGoutMRIMonosodium urate crystalsSpondylodiscitis

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Area of Science:

  • Rheumatology
  • Radiology
  • Orthopedics

Background:

  • Gout is the most prevalent inflammatory arthritis in adults.
  • Spinal involvement in gout affects 17% of patients and is frequently underdiagnosed.
  • Magnetic resonance imaging (MRI) has limitations in differentiating spinal gout from infectious spondylodiscitis, especially in post-surgical patients.

Purpose of the Study:

  • To highlight the diagnostic challenges of spinal gout in patients with a history of spinal surgery.
  • To demonstrate the utility of dual-energy computed tomography (DECT) in diagnosing spinal gout.
  • To present a case report illustrating the diagnostic process.

Main Methods:

  • Case report of an 80-year-old patient with lumbar back pain and prior spinal surgery.
  • Initial MRI revealed findings suggestive of spondylodiscitis.
  • Diagnosis was confirmed using DECT to detect monosodium urate crystals.

Main Results:

  • MRI findings were inconclusive for gout and initially suggested spondylodiscitis.
  • Surgical biopsy was negative for infection but did not confirm gout.
  • DECT successfully identified monosodium urate crystals, establishing the diagnosis of spinal gout.

Conclusions:

  • Spinal gout can mimic infectious spondylodiscitis on MRI, particularly in patients with a history of spinal surgery.
  • DECT is a valuable tool for differentiating spinal gout from other conditions by directly visualizing urate crystals.
  • Early and accurate diagnosis of spinal gout is crucial for appropriate management.