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Published in: Skeletal Radiology 4/2015

01-04-2015 | Review Article

The radiographic and MRI features of gout referred as suspected soft tissue sarcoma: a review of the literature and findings from 27 cases

Authors: Neil Upadhyay, Asif Saifuddin

Published in: Skeletal Radiology | Issue 4/2015

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Abstract

Gout has been termed the “great mimicker”, for its ability to resemble other pathological conditions. Whilst the typical imaging features of gout are well described, there is a relative paucity of literature describing more challenging cases of gout, where a malignant tumour has been considered in the differential diagnosis. The aim of this article is to provide an overview of the radiographic and MRI features of 27 cases of gout that were initially referred to our centre as suspected soft tissue sarcoma, alongside a review of the literature.
Literature
1.
go back to reference Cimmino MA, Zampogna G, Parodi M, Andracco R, Barbieri F, Paparo F, et al. MRI synovitis and bone lesions are common in acute gouty arthritis of the wrist even during the first attack. Ann Rheum Dis. 2011;70(12):2238–9.CrossRefPubMed Cimmino MA, Zampogna G, Parodi M, Andracco R, Barbieri F, Paparo F, et al. MRI synovitis and bone lesions are common in acute gouty arthritis of the wrist even during the first attack. Ann Rheum Dis. 2011;70(12):2238–9.CrossRefPubMed
2.
go back to reference Dhanda S, Jagmohan P, Quek S. A re-look at an old disease: a multimodality review on gout. Clin Radiol. 2012;67(2):193.CrossRef Dhanda S, Jagmohan P, Quek S. A re-look at an old disease: a multimodality review on gout. Clin Radiol. 2012;67(2):193.CrossRef
3.
go back to reference Amber H, Singh VA, Azura M. Gouty tophi mimicking synovial sarcoma of the knee joint. Turk J Rheumatol. 2012;27(3):208–11.CrossRef Amber H, Singh VA, Azura M. Gouty tophi mimicking synovial sarcoma of the knee joint. Turk J Rheumatol. 2012;27(3):208–11.CrossRef
4.
go back to reference Du Y, Pullman-Mooar S, Schumacher HR. Synovial sarcoma of the foot mimicking acute gouty arthritis. J Rheumatol. 2005;32(10):2006–8.PubMed Du Y, Pullman-Mooar S, Schumacher HR. Synovial sarcoma of the foot mimicking acute gouty arthritis. J Rheumatol. 2005;32(10):2006–8.PubMed
5.
go back to reference Morton MJ, Berquist TH, McLeod RA, Unni KK, Sim FH. MR imaging of synovial sarcoma. Am J Roentgenol. 1991;156(2):337–40.CrossRef Morton MJ, Berquist TH, McLeod RA, Unni KK, Sim FH. MR imaging of synovial sarcoma. Am J Roentgenol. 1991;156(2):337–40.CrossRef
6.
go back to reference Narváez J, Narváez J, Aguilera C, De Lama E, Portabella F. MR imaging of synovial tumors and tumor-like lesions. Eur Radiol. 2001;11(12):2549–60.CrossRefPubMed Narváez J, Narváez J, Aguilera C, De Lama E, Portabella F. MR imaging of synovial tumors and tumor-like lesions. Eur Radiol. 2001;11(12):2549–60.CrossRefPubMed
7.
go back to reference O’Sullivan P, Harris A, Munk P. Radiological features of synovial cell sarcoma. Br J Radiol. 2008;81(964):346–56.CrossRefPubMed O’Sullivan P, Harris A, Munk P. Radiological features of synovial cell sarcoma. Br J Radiol. 2008;81(964):346–56.CrossRefPubMed
8.
go back to reference Murphey MD, Gibson MS, Jennings BT, Crespo-Rodríguez AM, Fanburg-Smith J, Gajewski DA. Imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics. 2006;26(5):1543–65.CrossRefPubMed Murphey MD, Gibson MS, Jennings BT, Crespo-Rodríguez AM, Fanburg-Smith J, Gajewski DA. Imaging of synovial sarcoma with radiologic-pathologic correlation. Radiographics. 2006;26(5):1543–65.CrossRefPubMed
10.
go back to reference Li TJ, Lue KH, Lin ZI, Lu KH. Arthroscopic treatment for gouty tophi mimicking an intra-articular synovial tumor of the knee. Arthroscopy. 2006;22(8):910.e1–3.CrossRef Li TJ, Lue KH, Lin ZI, Lu KH. Arthroscopic treatment for gouty tophi mimicking an intra-articular synovial tumor of the knee. Arthroscopy. 2006;22(8):910.e1–3.CrossRef
11.
go back to reference Melloni P, Valls R, Yuguero M, Larrosa M. Unusual imaging manifestations of intraosseous tophaceous gout of the patella. J Rheumatol. 2005;32(5):959–61.PubMed Melloni P, Valls R, Yuguero M, Larrosa M. Unusual imaging manifestations of intraosseous tophaceous gout of the patella. J Rheumatol. 2005;32(5):959–61.PubMed
13.
go back to reference Garcia CO, Kutzbach AG, Espinoza LR. Characteristics of gouty arthritis in the Guatemalan population. Clin Rheumatol. 1997;16(1):45–50.CrossRefPubMed Garcia CO, Kutzbach AG, Espinoza LR. Characteristics of gouty arthritis in the Guatemalan population. Clin Rheumatol. 1997;16(1):45–50.CrossRefPubMed
15.
go back to reference Gerster JC, Landry M, Rappoport G, Rivier G, Duvoisin B, Schnyder P. Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis. 1996;55(12):921–3.CrossRefPubMedCentralPubMed Gerster JC, Landry M, Rappoport G, Rivier G, Duvoisin B, Schnyder P. Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis. 1996;55(12):921–3.CrossRefPubMedCentralPubMed
16.
go back to reference Forbess LJ, Fields TR. The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. Semin Arthritis Rheum. 2012;42(2):146–54.CrossRefPubMed Forbess LJ, Fields TR. The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. Semin Arthritis Rheum. 2012;42(2):146–54.CrossRefPubMed
17.
18.
go back to reference Iwamoto T, Toki H, Ikari K, Yamanaka H, Momohara S. Multiple extensor tendon ruptures caused by tophaceous gout. Mod Rheumatol. 2010;20(2):210–2.CrossRefPubMed Iwamoto T, Toki H, Ikari K, Yamanaka H, Momohara S. Multiple extensor tendon ruptures caused by tophaceous gout. Mod Rheumatol. 2010;20(2):210–2.CrossRefPubMed
19.
go back to reference Poh YJ, Dalbeth N, Doyle A, McQueen FM. Magnetic resonance imaging bone edema is not a major feature of gout unless there is concomitant osteomyelitis: 10-year findings from a high-prevalence population. J Rheumatol. 2011;38(11):2475–81.CrossRefPubMed Poh YJ, Dalbeth N, Doyle A, McQueen FM. Magnetic resonance imaging bone edema is not a major feature of gout unless there is concomitant osteomyelitis: 10-year findings from a high-prevalence population. J Rheumatol. 2011;38(11):2475–81.CrossRefPubMed
20.
go back to reference Lagoutaris ED, Adams HB, DiDomenico LA, Rothenberg RJ. Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration. A case report. J Foot Ankle Surg. 2005;44(3):222–4.CrossRefPubMed Lagoutaris ED, Adams HB, DiDomenico LA, Rothenberg RJ. Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration. A case report. J Foot Ankle Surg. 2005;44(3):222–4.CrossRefPubMed
21.
go back to reference Narváez JA, Narváez J, Ortega R, De Lama E, Roca Y, Vidal N. Hypointense synovial lesions on T2-weighted images: differential diagnosis with pathologic correlation. Am J Roentgenol. 2003;181(3):761–9.CrossRef Narváez JA, Narváez J, Ortega R, De Lama E, Roca Y, Vidal N. Hypointense synovial lesions on T2-weighted images: differential diagnosis with pathologic correlation. Am J Roentgenol. 2003;181(3):761–9.CrossRef
22.
go back to reference Bloch C, Hermann G, Yu TF. A radiologic reevaluation of gout: a study of 2,000 patients. Am J Roentgenol. 1980;134(4):781–7.CrossRef Bloch C, Hermann G, Yu TF. A radiologic reevaluation of gout: a study of 2,000 patients. Am J Roentgenol. 1980;134(4):781–7.CrossRef
23.
go back to reference Schlesinger N, Thiele RG. The pathogenesis of bone erosions in gouty arthritis. Ann Rheum Dis. 2010;69(11):1907–12.CrossRefPubMed Schlesinger N, Thiele RG. The pathogenesis of bone erosions in gouty arthritis. Ann Rheum Dis. 2010;69(11):1907–12.CrossRefPubMed
24.
go back to reference Choi MH, MacKenzie JD, Dalinka MK. Imaging features of crystal-induced arthropathy. Rheum Dis Clin N Am. 2006;32(2):427–46.CrossRef Choi MH, MacKenzie JD, Dalinka MK. Imaging features of crystal-induced arthropathy. Rheum Dis Clin N Am. 2006;32(2):427–46.CrossRef
25.
go back to reference Martel W. The overhanging margin of bone: a roentgenologic manifestation of gout. Radiology. 1968;91(4):755–6.CrossRefPubMed Martel W. The overhanging margin of bone: a roentgenologic manifestation of gout. Radiology. 1968;91(4):755–6.CrossRefPubMed
26.
go back to reference Rothschild BM, Heathcote GM. Characterization of gout in a skeletal population sample: presumptive diagnosis in a micronesian population. Am J Phys Anthropol. 1995;98(4):519–25.CrossRefPubMed Rothschild BM, Heathcote GM. Characterization of gout in a skeletal population sample: presumptive diagnosis in a micronesian population. Am J Phys Anthropol. 1995;98(4):519–25.CrossRefPubMed
27.
go back to reference Dalbeth N, Clark B, Gregory K, Gamble G, Sheehan T, Doyle A, et al. Mechanisms of bone erosion in gout: a quantitative analysis using plain radiography and computed tomography. Ann Rheum Dis. 2009;68(8):1290–5.CrossRefPubMed Dalbeth N, Clark B, Gregory K, Gamble G, Sheehan T, Doyle A, et al. Mechanisms of bone erosion in gout: a quantitative analysis using plain radiography and computed tomography. Ann Rheum Dis. 2009;68(8):1290–5.CrossRefPubMed
28.
go back to reference McQueen FM, Doyle A, Reeves Q, Gao A, Tsai A, Gamble GD, et al. Bone erosions in patients with chronic gouty arthropathy are associated with tophi but not bone oedema or synovitis: new insights from a 3 T MRI study. Rheumatology. 2014;53(1):95–103.CrossRefPubMed McQueen FM, Doyle A, Reeves Q, Gao A, Tsai A, Gamble GD, et al. Bone erosions in patients with chronic gouty arthropathy are associated with tophi but not bone oedema or synovitis: new insights from a 3 T MRI study. Rheumatology. 2014;53(1):95–103.CrossRefPubMed
29.
go back to reference McQueen FM, Chhana A, Dalbeth N. Mechanisms of joint damage in gout: evidence from cellular and imaging studies. Nat Rev Rheumatol. 2012;8(3):173–81.CrossRefPubMed McQueen FM, Chhana A, Dalbeth N. Mechanisms of joint damage in gout: evidence from cellular and imaging studies. Nat Rev Rheumatol. 2012;8(3):173–81.CrossRefPubMed
30.
go back to reference Chen CK, Yeh LR, Pan HB, Yang CF, Lu YC, Wang JS, et al. Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients. Skeletal Radiol. 1999;28(2):75–80.CrossRefPubMed Chen CK, Yeh LR, Pan HB, Yang CF, Lu YC, Wang JS, et al. Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients. Skeletal Radiol. 1999;28(2):75–80.CrossRefPubMed
31.
go back to reference Chen CK, Chung CB, Yeh L, Pan HB, Yang CF, Lai PH, et al. Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients. AJR Am J Roentgenol. 2000;175(3):655–9.CrossRefPubMed Chen CK, Chung CB, Yeh L, Pan HB, Yang CF, Lai PH, et al. Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients. AJR Am J Roentgenol. 2000;175(3):655–9.CrossRefPubMed
32.
go back to reference De Avila Fernandes E, Kubota ES, Sandim GB, Mitraud SA, Ferrari AJ, Fernandes AR. Ultrasound features of tophi in chronic tophaceous gout. Skeletal Radiol. 2011;40(3):309–15.CrossRefPubMed De Avila Fernandes E, Kubota ES, Sandim GB, Mitraud SA, Ferrari AJ, Fernandes AR. Ultrasound features of tophi in chronic tophaceous gout. Skeletal Radiol. 2011;40(3):309–15.CrossRefPubMed
33.
go back to reference Yu J, Chung C, Recht M, Dailiana T, Jurdi R. MR imaging of tophaceous gout. AJR Am J Roentgenol. 1997;168(2):523–7.CrossRefPubMed Yu J, Chung C, Recht M, Dailiana T, Jurdi R. MR imaging of tophaceous gout. AJR Am J Roentgenol. 1997;168(2):523–7.CrossRefPubMed
34.
35.
go back to reference Paparo F, Zampogna G, Fabbro E, Parodi M, Andracco R, Ferrero G, et al. Imaging of tophi with an extremity-dedicated MRI system. Clin Exp Rheumatol. 2011;29(3):519–26.PubMed Paparo F, Zampogna G, Fabbro E, Parodi M, Andracco R, Ferrero G, et al. Imaging of tophi with an extremity-dedicated MRI system. Clin Exp Rheumatol. 2011;29(3):519–26.PubMed
36.
go back to reference Carter JD, Kedar RP, Anderson SR, Osorio AH, Albritton NL, Gnanashanmugam S, et al. An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology. 2009;48(11):1442–6.CrossRefPubMed Carter JD, Kedar RP, Anderson SR, Osorio AH, Albritton NL, Gnanashanmugam S, et al. An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology. 2009;48(11):1442–6.CrossRefPubMed
37.
go back to reference Perez-Ruiz F, Martin I, Canteli B. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J Rheumatol. 2007;34(9):1888–93.PubMed Perez-Ruiz F, Martin I, Canteli B. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J Rheumatol. 2007;34(9):1888–93.PubMed
38.
go back to reference Perez-Ruiz F, Calabozo M, Pijoan JI, Herrero-Beites AM, Ruibal A. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Care Res. 2002;47(4):356–60.CrossRef Perez-Ruiz F, Calabozo M, Pijoan JI, Herrero-Beites AM, Ruibal A. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Care Res. 2002;47(4):356–60.CrossRef
39.
go back to reference Ko KH, Hsu YC, Lee HS, Lee CH, Huang GS. Tophaceous gout of the knee: revisiting MRI patterns in 30 patients. J Clin Rheumatol. 2010;16(5):209–14.CrossRefPubMed Ko KH, Hsu YC, Lee HS, Lee CH, Huang GS. Tophaceous gout of the knee: revisiting MRI patterns in 30 patients. J Clin Rheumatol. 2010;16(5):209–14.CrossRefPubMed
40.
go back to reference Dalbeth N, Doyle AJ. Imaging of gout—an overview. Best Pract Res Clin Rheumatol. 2012;26(6):823–38.CrossRefPubMed Dalbeth N, Doyle AJ. Imaging of gout—an overview. Best Pract Res Clin Rheumatol. 2012;26(6):823–38.CrossRefPubMed
41.
go back to reference Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 2011;31(5):1365–75.CrossRefPubMed Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics. 2011;31(5):1365–75.CrossRefPubMed
42.
go back to reference Barthelemy C, Nakayama D, Carrera G, Lightfoot Jr R, Wortmann R. Gouty arthritis: a prospective radiographic evaluation of sixty patients. Skeletal Radiol. 1984;11(1):1–8.CrossRefPubMed Barthelemy C, Nakayama D, Carrera G, Lightfoot Jr R, Wortmann R. Gouty arthritis: a prospective radiographic evaluation of sixty patients. Skeletal Radiol. 1984;11(1):1–8.CrossRefPubMed
43.
go back to reference Rettenbacher T, Ennemoser S, Weirich H, Ulmer H, Hartig F, Klotz W, et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. Eur Radiol. 2008;18(3):621–30.CrossRefPubMed Rettenbacher T, Ennemoser S, Weirich H, Ulmer H, Hartig F, Klotz W, et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. Eur Radiol. 2008;18(3):621–30.CrossRefPubMed
44.
go back to reference Brant WE, Helms CA. Fundamentals of diagnostic radiology. Philadelphia: Lippincott Williams & Wilkins; 2012. Brant WE, Helms CA. Fundamentals of diagnostic radiology. Philadelphia: Lippincott Williams & Wilkins; 2012.
45.
go back to reference Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. I. Diagnosis. Report of a task force of the standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1301–11.CrossRefPubMedCentralPubMed Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. I. Diagnosis. Report of a task force of the standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1301–11.CrossRefPubMedCentralPubMed
46.
go back to reference Girish G, Glazebrook KN, Jacobson JA. Advanced imaging in gout. Am J Roentgenol. 2013;201(3):515–25.CrossRef Girish G, Glazebrook KN, Jacobson JA. Advanced imaging in gout. Am J Roentgenol. 2013;201(3):515–25.CrossRef
47.
go back to reference Harris MD, Siegel LB, Alloway JA. Gout and hyperuricemia. Am Fam Physician. 1999;59(4):925–34.PubMed Harris MD, Siegel LB, Alloway JA. Gout and hyperuricemia. Am Fam Physician. 1999;59(4):925–34.PubMed
48.
go back to reference Urano W, Yamanaka H, Tsutani H, Nakajima H, Matsuda Y, Taniguchi A, et al. The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis. J Rheumatol. 2002;29(9):1950–3.PubMed Urano W, Yamanaka H, Tsutani H, Nakajima H, Matsuda Y, Taniguchi A, et al. The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis. J Rheumatol. 2002;29(9):1950–3.PubMed
49.
go back to reference Gerster JC, Landry M, Duvoisin B, Rappoport G. Computed tomography of the knee joint as an indicator of intraarticular tophi in gout. Arthritis Rheum. 1996;39(8):1406–9.CrossRefPubMed Gerster JC, Landry M, Duvoisin B, Rappoport G. Computed tomography of the knee joint as an indicator of intraarticular tophi in gout. Arthritis Rheum. 1996;39(8):1406–9.CrossRefPubMed
50.
go back to reference Gerster JC, Landry M, Dufresne L, Meuwly JY. Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis. 2002;61(1):52–4.CrossRefPubMedCentralPubMed Gerster JC, Landry M, Dufresne L, Meuwly JY. Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis. 2002;61(1):52–4.CrossRefPubMedCentralPubMed
51.
go back to reference Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int. 2010;30(4):495–503.CrossRefPubMed Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int. 2010;30(4):495–503.CrossRefPubMed
52.
go back to reference Lai K-L, Chiu Y-M. Role of ultrasonography in diagnosing gouty arthritis. J Med Ultrasound. 2011;19(1):7–13.CrossRef Lai K-L, Chiu Y-M. Role of ultrasonography in diagnosing gouty arthritis. J Med Ultrasound. 2011;19(1):7–13.CrossRef
53.
54.
go back to reference Nicolaou S, Yong-Hing CJ, Galea-Soler S, Hou DJ, Louis L, Munk P. Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. Am J Roentgenol. 2010;194(4):1072–8.CrossRef Nicolaou S, Yong-Hing CJ, Galea-Soler S, Hou DJ, Louis L, Munk P. Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. Am J Roentgenol. 2010;194(4):1072–8.CrossRef
55.
go back to reference Choi HK, Al-Arfaj AM, Eftekhari A, Munk PL, Shojania K, Reid G, et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis. 2009;68(10):1609–12.CrossRefPubMed Choi HK, Al-Arfaj AM, Eftekhari A, Munk PL, Shojania K, Reid G, et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis. 2009;68(10):1609–12.CrossRefPubMed
56.
go back to reference Glazebrook KN, Kakar S, Ida CM, Laurini JA, Moder KG, Leng S. False-negative dual-energy computed tomography in a patient with acute gout. J Clin Rheumatol. 2012;18(3):138–41.CrossRefPubMed Glazebrook KN, Kakar S, Ida CM, Laurini JA, Moder KG, Leng S. False-negative dual-energy computed tomography in a patient with acute gout. J Clin Rheumatol. 2012;18(3):138–41.CrossRefPubMed
Metadata
Title
The radiographic and MRI features of gout referred as suspected soft tissue sarcoma: a review of the literature and findings from 27 cases
Authors
Neil Upadhyay
Asif Saifuddin
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 4/2015
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-014-2005-4

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