Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings.
OBJECTIVE
To explore the typical sonographic features of gray-scale and Power Doppler of acute and chronic gouty arthritis in conjunction with radiographic, clinical, and laboratory findings.


METHODS
All hand, finger, and toe joints of 19 patients with acute and chronic gout were examined with gray-scale and Power Doppler sonography. The number and size of bone changes detected with sonography was compared to radiographic findings. Vascularization of the synovial tissue was scored on Power Doppler (grades 0-3), and was compared with clinical appearance, including swelling, tenderness, and redness (grades 0-3).


RESULTS
In acute gout, mild to moderate echogenic periarticular nodules with sonotransmission and hypervascularization of the edematous surrounding soft tissue were found. In chronic gout, tophaceous nodules completely blocked transmission of US wave, leading to strong reflexion and dorsal shadowing in a minority of cases. No significant difference in the detection of large bone changes (>2mm) was found between sonography and radiography. However, gray-scale sonography was significantly more sensitive in the detection of small bone changes (p<0.001). Power Doppler scores were statistically significantly higher than clinical examination scores (p<0.001).


CONCLUSIONS
Sonography is superior to radiographs in evaluating small bone changes. The inflammatory process in joints can be better detected with Power Doppler sonography than with clinical examination. Typical sonographic appearance of acute and in particular of chronic gout might provide clues on gouty arthritis that adds to the information available from conventional radiography, clinical, and laboratory findings.
Schueller-Weidekamm
Claudia
C
Department of Diagnostic Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. claudia.schueller-weidekamm@meduniwien.ac.at
Schueller
Gerd
G
Aringer
Martin
M
Weber
Michael
M
Kainberger
Franz
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015210:Arthritis, Gouty / Q000097:blood* / Q000175:diagnosis*; D001175:Arthrography / Q000379:methods*; D001799:Blood Sedimentation; D002097:C-Reactive Protein; D003430:Cross-Sectional Studies; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging; D050823:Hand Joints / Q000000981:diagnostic imaging; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D014033:Toe Joint / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler / Q000379:methods*; D014527:Uric Acid / Q000097:blood
D014527:Uric Acid; D002097:C-Reactive Protein