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Ultrasound may help identify un-calcified tophi undetected by radiography
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Un-calcified tophaceous deposits that were undetected with conventional radiography may be visible on musculoskeletal ultrasound, according to recently published data.
Researchers evaluated 24 patients (21 men) diagnosed with gout who had previously reported at least one hand arthritis event. A Prosound 7 (Hitachi-Aloka Medical) ultrasound device with a multifrequency linear probe was used to evaluate hand joints by a rheumatologist blinded to clinical findings. Forty-eight metacarpophalangeal joints were evaluated by ultrasound and conventional radiography was used to image the anteroposterior and lateral views of the hand.
Ultrasound was used to detect cortical erosions which were defined as “breaks in the cortical contour of the metacarpal head or proximal phalanx” viewed in two perpendicular planes. Ultrasound was also used to detect tophaceous deposits which were defined as “hyperechoic crystalline concrements and calcified tophi.”
Ultrasound detected significantly more erosions than conventional radiography. Erosions were identified in 23 joints (47.9%) by ultrasound compared to erosions in five joints detected with conventional radiography. Intra-articular tophaceous deposits in 39 joints were identified with ultrasound while conventional radiographs revealed no un-calcified material in any joints. Intra-articular calcified tophi were detected in three joints using ultrasound compared to two of 48 joints with conventional radiography.
“Musculoskeletal ultrasound is an extremely valuable tool in the evaluation of gouty arthritis of the hand, identifying a significantly higher number of erosions compared to radiographic evaluation as well as in visualizing the intra-articular tophaceous deposits,” the researchers wrote. “While un-calcified tophaceous deposits are missed by the conventional radiologic evaluation, calcified tophi are seen by both imaging methods.” – by Shirley Pulawski
Reference:
Musetescu AE, et al. Paper #AB1040. Presented at: European League Against Rheumatism Annual European Congress of Rheumatology. June 10-13, 2015; Rome.
Disclosure: The researchers report no relevant financial disclosures.