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Gout diagnosis can be elusive: Inexperienced clinicians often are reluctant to perform arthrocentesis, and even experienced clinicians sometimes fail to obtain fluid via arthrocentesis. Dual-energy computed tomography (CT) is a relatively new approach to gout diagnosis that provides images in which gout crystals appear as specifically colored densities in affected joints or periarticular soft tissue (an image can be found at the Journal of Rheumatology).
In a study from Mayo Clinic, 31 patients with suspected gout all underwent both dual-energy CT and successful arthrocentesis. Uric acid crystals were identified in synovial fluid in 12 patients, and CT was positive in all of them (100% sensitivity). In the 19 patients whose fluid was negativ…