Aim: To define the magnetic resonance (MR) imaging features of tophaceous gout of the spine. Materials and methods: We present the MR imaging examinations of 4 patients with spinal tophaceous gout. Spin-echo T1-weighted and fast spin-echo T2-weighted images were obtained for all patients, and 2 patients had gadolinium-enhanced MR imaging studies. Corresponding computed tomography (CT) was performed in one patient. All images were evaluated for the characteristics of the gouty tophi. Results: The gouty tophi were located at the lower thoracic (n = 1) and lumbar (n = 3) levels. All tophi yielded homogeneous intermediate to low signal on T1-weighted images and variable signal intensity on T2-weighted images, comprising small foci of very low signal intensity on all sequences. Gadolinium-enhanced MR imaging studies revealed homogeneous enhancement or heterogeneous peripheral enhancement. Diffuse stippled calcifications were found in the tophi on CT images. Periarticular tophi with juxtaarticular bony erosions around facet joints occurred in 3 patients. Conclusion: Spinal tophaceous gout should be considered in the differential diagnosis when periarticular deposits contain very low signal foci on all MR imaging sequences.
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