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<v ->Gouty deposition within tendons is also recognized.

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Generally associated with tendon enlargement,

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low to intermediate signal intensity and tendon tearing.

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In this example of gout with classic involvement

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of the metatarsal phalangeal joint of the great toe.

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There's also involvement of the tibialis anterior tendon.

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Anteriorly at the level of the ankle,

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it is markedly enlarged.

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It has intermediate to low signal intensity,

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classic example of gout.

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Similarly, gout may involve the tendons of the rotator cuff.

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In case, as we look at the conventional radiograph,

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there is cloud-like increased density

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within the tendon shown here on CT,

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including dual energy CT,

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and shown here on a variety of MR sequences.

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This can look like tendonosis or tendon tearing,

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but the basic pathology is urate deposition

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within the tendon.

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Tophi within soft tissues are also clearly recognized

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in gout.

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People have studied the MR imaging characteristics

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of these tophi, trying to compare them

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to the characteristics of rheumatoid nodules.

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First, there's overlap between that, those appearances,

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in tophi and rheumatoid nodules.

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Second, those manifestations are highly variable.

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The degree of gadolinium enhancement can be minimal

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or marked.

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It generally is not homogeneous as in this case

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and as I indicated earlier,

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typically gouty deposits

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are of low or intermediate signal within,

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even on the fluid sensitive sequences.

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A dramatic example of widespread gouty involvement

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of the wrist and of the fingers

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leading to massive enlargement of bone and of soft tissue.

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Oh, and I love this picture.

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Here is the typical involvement of gout

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involving the wrist pan compartmental,

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meaning all of the compartments of the wrist

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with predilection for the common carpal

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metacarpal compartment of the wrist.

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That is a classic site of gouty involvement.