MAGNETIC-RESONANCE-IMAGING OF TOPHACEOUS GOUT IN THE HANDS AND WRISTS

The objective of this study was to determine the relative usefulness o f physical examination, plain radiographs, and magnetic resonance imag ing (MRI) using T1- and T2-weighted spin-echo images in evaluating the extent of urate deposition and soft tissue destruction in gouty arthr itis, Seven patients with chronic tophaceous gout of the hands and wri sts were examined to identify all clinically apparent tophi, Plain rad iographs of the hands and wrist were obtained to further quantify soft tissue and osseous changes. MRI was then performed of the involved ar eas and a comparison made between soft tissue and bony changes observe d by clinical examination and plain radiographs and those observed by MRI. Plain radiographs and physical examination markedly underestimate the size and extent of soft tissue and osseous involvement by tophi w hen compared with the findings of MRI, MRI also detects early, subclin ical tophaceous deposits and indicates that urate deposits appear to s pread along compartmental and fascial planes as opposed to the traditi onal view of strict radial growth, MRI is a useful method of determini ng the extent of disease in tophaceous gout and may provide informatio n regarding the patterns of deposition and spread of monosodium urate crystals. (C) 1996 by W.B. Saunders Company