Gout tophus detection-a comparison of dual-energy CT (DECT) and histology

Semin Arthritis Rheum. 2014 Apr;43(5):662-5. doi: 10.1016/j.semarthrit.2013.11.002. Epub 2013 Nov 12.


Objectives: To compare dual-energy CT images (DECT) directly with gold standard histology.

Methods: A 85-year-old woman with chronic recurrent gouty arthritis and macroscopically visible tophi was assessed with DECT-scans of her feet. When she died 7 days later, three tophi in different regions and in different tissues of her left foot were processed for histological examination.

Results: Of the selected tophi, two were almost completely missed by the color-coding DECT sequences. The tophi remained in most of their volume below the detection threshold value of 150HU (default value).

Conclusions: It could be demonstrated that DECT only highlights the dense tophi (corresponding of approximately 15-20vol% urate in the tophus). Less dense tophi, despite considerable size, will be missed in the color-coded images.

Keywords: DECT; Dual-energy computed tomography; Gout; Histology; Tophi.

Publication types

  • Case Reports
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Arthritis, Gouty / diagnosis*
  • Arthritis, Gouty / diagnostic imaging
  • Arthritis, Gouty / pathology
  • Female
  • Humans
  • Radiography