Gout — SCE Rheumatology MCQ
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Correct answer: B — Colour-coded periarticular deposits
The correct answer is B. DECT acquires images at two energy levels and uses material-decomposition algorithms to distinguish monosodium urate from calcium-containing material. Presumed urate deposits are displayed as colour-coded overlays in joints, tendons and periarticular soft tissues. Punched-out erosions may occur in chronic gout but represent structural damage and are not specific to crystal composition. Linear cartilage calcification suggests calcium pyrophosphate deposition. Joint-space narrowing is non-specific, and periosteal reaction is not a characteristic gout finding. The original term “pathognomonic” was too absolute: colour-coded lesions can include artefact or calcium-containing mimics, particularly at certain anatomical sites, so DECT must be interpreted with artefact recognition and clinical correlation.
Reference: Mandl P et al. 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice, Recommendations 2–3. Annals of the Rheumatic Diseases. 2024;83:752–759. https://ard.bmj.com/content/83/6/752