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Carpal Tunnel Syndrome Caused by Tophaceous Gout

CT and MR Imaging Features in 20 Patients

Clement K. H. Chen1,2, Christine B. Chung3, LeeRen Yeh1,2, Huay-Ben Pan1,2, Chien-Fang Yang1,2, Ping-Hong Lai1,2, Huei-Lung Liang1,2 and Donald Resnick3

1 Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd. Kaohsiung, 813 Taiwan.
2 National Yang-Ming University, School of Medicine, 155, Sec 2, Li-Nong St., Shih-Pai Rd., PeiTou, Taipei, 112 Taiwan.
3 Department of Radiology, Veterans Affairs Medical Center and University of California-San Diego, 3350 La Jolla Village Dr., San Diego, CA 92161.



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  		Fig. 1A. —Carpal tunnel syndrome induced by tophaceous gout in 69-year-old man. Axial T1-weighted spin-echo MR image (TR/TE, 550/19) (A), axial T2-weighted fat-suppressed fast spin-echo MR image (TR/effective TE, 3400/80) (B), and gadolinium-enhanced T1-weighted spin-echo MR image (TR/TE, 466/19) (C) show gouty tophi deposition in carpal tunnel floor (solid straight arrows), flexor tendons (arrowheads), extensor tendons and sheaths (curved arrows), and carpal bones (open arrows). Depositions are seen as areas of intermediate signal intensity with foci of low signal intensity on A and B. On C, note enhancement of tophi except those in carpal tunnel floor.

 


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  		Fig. 2C. —Carpal tunnel syndrome induced by tophaceous gout in 57-year-old man. Gadolinium-enhanced T1-weighted spin-echo MR image (650/13) shows prominent enhancement.

 


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  		Fig. 1B. —Carpal tunnel syndrome induced by tophaceous gout in 69-year-old man. Axial T1-weighted spin-echo MR image (TR/TE, 550/19) (A), axial T2-weighted fat-suppressed fast spin-echo MR image (TR/effective TE, 3400/80) (B), and gadolinium-enhanced T1-weighted spin-echo MR image (TR/TE, 466/19) (C) show gouty tophi deposition in carpal tunnel floor (solid straight arrows), flexor tendons (arrowheads), extensor tendons and sheaths (curved arrows), and carpal bones (open arrows). Depositions are seen as areas of intermediate signal intensity with foci of low signal intensity on A and B. On C, note enhancement of tophi except those in carpal tunnel floor.

 


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  		Fig. 2B. —Carpal tunnel syndrome induced by tophaceous gout in 57-year-old man. Coronal fat-suppressed T2-weighted fast spin-echo MR image (4100/80) shows intermediate to high signal intensity.

 


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  		Fig. 3B. —Carpal tunnel syndrome induced by tophaceous gout in 57-year-old man. Axial fat-suppressed T2-weighted fast spin-echo MR image (TR/TE, 6000/80) shows tophi (arrows) with low to intermediate signal intensity.

 


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  		Fig. 1D. —Carpal tunnel syndrome induced by tophaceous gout in 69-year-old man. Axial CT scan obtained immediately after MR imaging shows diffuse calcification (arrow) in tophi.

 


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  		Fig. 3A. —Carpal tunnel syndrome induced by tophaceous gout in 57-year-old man. Axial CT scan shows calcification (straight arrows) in carpal tunnel floor and extensor tendons and sheaths (curved arrow).

 


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  		Fig. 1C. —Carpal tunnel syndrome induced by tophaceous gout in 69-year-old man. Axial T1-weighted spin-echo MR image (TR/TE, 550/19) (A), axial T2-weighted fat-suppressed fast spin-echo MR image (TR/effective TE, 3400/80) (B), and gadolinium-enhanced T1-weighted spin-echo MR image (TR/TE, 466/19) (C) show gouty tophi deposition in carpal tunnel floor (solid straight arrows), flexor tendons (arrowheads), extensor tendons and sheaths (curved arrows), and carpal bones (open arrows). Depositions are seen as areas of intermediate signal intensity with foci of low signal intensity on A and B. On C, note enhancement of tophi except those in carpal tunnel floor.

 


View larger version (130K):

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  		Fig. 3C. —Carpal tunnel syndrome induced by tophaceous gout in 57-year-old man. Gadolinium-enhanced fat-suppressed T1-weighted spin-echo MR image (400/13) shows tophi (open arrow) in carpal tunnel floor with low signal intensity, whereas gadolinium enhancement of tophi is evident in extensor tendons and sheaths (solid arrows).

 


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  		Fig. 2A. —Carpal tunnel syndrome induced by tophaceous gout in 57-year-old man. Coronal T1-weighted spin-echo MR image (TR/TE, 466/15) shows extensive gouty tophi in radio carpal joint (short arrows) and carpal bones (long arrows), which manifest intermediate signal intensity with foci of low signal intensity.

 

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