Evaluation of Tophaceous Gout by FDG-PET/CT and Bone Scan
Gottfried Wimmer, Simon W. Stoecklegger, Tatjana Stojakovic, Josef F. Hofer and Robert Pichler
Affiliation: Institute of Nuclear Medicine, Wagner-Jauregg Hospital, Linz, Austria.
We report the case of a 76 year old male patient with a clinical history of gouty arthritis and multiple enormous
gouty tophus for decades. Medical history as well presented prostate cancer, arterial hypertension and chronic atrial fibrillation.
Hospitalisation became necessary in October 2011 due to duodenal ulcer. At this time no specific medication for
gout was taken. Serum urine acid and CRP were in the normal range. Bone scan showed multifocal arthritis in small finger
joints of both hands, activation was present only in the left PIP joint of digit IV. The diphosphonate tracer was not
captured by the subcutaneous tophus of the right hand. Additional evaluation of inflammatory processes by FDG-PET/CT
was done in succession, both tophi presented augmented glucose metabolism with an SUV of about 2. After efficient
treatment with proton pump inhibitors and healing of ulcer disease verified by endoscopic control examination, medication
for gout with allopurinol and diclofenac was reinitialised. We recommend to consider the use of nuclear medicine imaging
in gouty arthritis and tophus additionally to radiological methods or via hybrid imaging to visualise inflammation in
joints and further involved tissue.
Keywords: Bone scan, FDG, gout, PET.
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