Musculoskeletal MRI Unknown Cases
Texas Radiologic Society 93rd Annual Scientific Meeting Austin, TX April 21-23, 2006
Lezlie R Warren, MD CPT USAF Justin Q Ly, MD CPT USAF Douglas P Beall, MD Wilford Hall Medical Center San Antonio, TX
Case 1
87 y/o male with pain
T1
T1 post
T1 T2 FS
Diagnosis?
Gout
Gout
• Recurrent arthritis caused by hyperuricemia • Hyperuricemia caused by overproduction or decreased excretion of uric acid • Chronic gout can result in deposition of urate crystals in the soft tissue surrounding the joints (tophi) and within joint cartilage • Negatively birefringent (yellow)
Gout
• Imaging Findings:
– Asymmetric sharply marginated erosions with “overhanging edges” and sclerotic borders – Relative lack of osteoporosis – Preservation of joint spaces – Dense soft tissue masses (tophi) – MRI:
• Intermediate signal on T1 series • Intermediate to low signal on T2 series
Gout
• DDx:
– – – – Rheumatoid arthritis PVNS Synovial chondromatosis Amyloidosis
• Treatment:
– NSAIDS for acute attacks – Probenacid, Colchicine and Allopurinol for long-term management – Purine free diet