Gout, The Great Mimic

Gout has a new diagnostic tool detecting dual-energy computed tomograhy (DECT)

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Gout may be difficult for doctors to diagnose because symptoms can mimic or coexist with many other conditions including psoriasis, nodular rheumatoid disease and other joint diseases.

Researchers wanting a more definitive diagnostic tool for gout have created a new dual-energy Computed Topography (DECT) tool that looks promising for diagnosing and assessing the severity of gout.

"A less-invasive method of gout detection may provide early treatment opportunities."

Khalid Khashoggi, MD, a physician with Vancouver General Hospital, Vancouver, Canada and one of the authors of the study shares that a non-invasive means of diagnosing gout is highly desirable and dual-energy CT may be just what the doctor ordered.

DECT can detect monosodium urate in different tissues in the body, which will have a huge impact on understanding of gout. It will also help detect early cases of gout and allow a better monitoring response to gout treatment, and help in solving atypical gout cases.

This system uses two radiography tubes scanning at 80 kvp and 140 kvp. This allows for color coding the patient's uric acid and calcium based on lowering the intensity levels of the radiography energy.

DECT has the potential to allow noninvasive diagnosis of gout, and measurement of total body uric acid through 3D volume assessment. Current diagnostic tools for gout include extracting synovial fluid samples taken from an infected joint.

This can be painful though and does not measure synovial fluid in other parts of the body. DECT might also obviate needle aspiration in difficult to access anatomic sites such as the spine.

The exciting novel applications:

  • Education Goals
  • Teaching Points
  • Anatomic/Physiologic Issues 
  • Imaging Findings/Techniques

The Study

  • Unusual distributions of joint disease and soft tissue crystal deposition are identified, including previously undetectable patterns within the ligaments of the knee
  • Chronic tophaceous gout often shows up as a lesion arising adjacent to a large joint and soft-tissue masses with erosions which are overhanging bony margins. There isalso a thickening of the synovium
  • Structural changes in plain radiographs usually means poor function and can mean it is irreversibile.
  • DECT's ability to detect early changes of gout makes it have important role in early treatment and potential prevention of irreversible structural deformities
  • DECT reader, with its enhanced imaging will be able to see unusual presentations of gout and its wide ranging appearances.
  • Over six million people in the United States have gout
Reviewed by: 
Review Date: 
May 9, 2011
Last Updated:
May 16, 2011