Ultrasound features of tophi in chronic tophaceous gout.

OBJECTIVE: To describe the different and lesser-known ultrasound features of tophi in chronic tophaceous gout. METHODS: Ultrasound images of 138 affected areas were analyzed from 31 patients with gout, using high-quality broadband linear transducers (frequency range of 8-14 MHz). Tophi were classified relative to echogenicity, echotexture, contours, number and the presence or absence of hypoechoic halo. The duration of illness was correlated with the presence of calcifications in tophi. RESULTS: Hyperechoic tophi were seen in 133 areas (96.3%); these were most frequently hyperechoic and heterogeneous (37.6%) or hyperechoic and heterogeneous with calcification (32.6%). Contours were found to be poorly defined in 115 (83.3%) areas. Multiple grouped tophi were seen in 85 areas (61.6%) and 50 areas (36.2%) had individual tophi. In 77 examined areas (55.8%), there was a hypoechoic halo around the tophi. There was no correlation between illness duration and presence of calcifications on tophi. CONCLUSIONS: Tophi are generally hyperechoic, heterogeneous, with poorly defined contours, multiple grouped and surrounded by an anechoic halo. Individual tophus and the absence of association between illness duration and the presence of calcification are newly described features. This study of tophaceous gout by ultrasound may contribute to the diagnostic elucidation of patients with clinically atypical gout and show its diverse characteristic forms of presentation.

Temporopolar blurring in temporal lobe epilepsy with hippocampal sclerosis and long-term prognosis after epilepsy surgery.

PURPOSE: We conducted a retrospective study in order to investigate the clinical significance of temporopolar grey/white matter abnormalities (GWMA) in patients with temporal lobe epilepsy (TLE) and unilateral hippocampal sclerosis (HS) with a long post-surgical follow-up. METHODS: The study comprised 122 consecutive patients with medically refractory TLE and unilateral HS who underwent epilepsy surgery and had a minimum postoperative follow-up of 5 years. Patients were divided into two groups, based on findings of pre-surgical MRI: group 1 with GWMA and 2 with normal signal and grey/white matter definition in temporal pole. Demographic and clinical data were reviewed and compared between groups. RESULTS: GWMA were found in 52.5% of patients, always ipsilateral to HS. Compared with group 2, group 1 patients had earlier epilepsy onset (mean, 9.3 vs 14.4 years, P=0.001), a higher occurrence of first seizure ≤2 years of age (25.8% vs 10.5%, P=0.036; OR=2.96 [95% CI=1.07-8.19]), and greater prevalence of left HS (76.6% vs 43.1%, P<0.001; OR=4.31 [95% CI=1.98-9.38]). No differences were found in gender, presence or type of initial precipitating injury, history of secondary generalized seizures, duration of epilepsy, seizure frequency before surgery, neuropsychological evaluation and presence or lateralization of pre-surgical interictal epileptiform discharges. Postoperative follow-up varied from 5 to 11.5 years (mean 7.4) and was similar in both groups (P=0.155). The proportion of patients classified as seizure-free (Engel class I) at last follow-up in groups 1 and 2 were 73.4% and 69%, respectively (P=0.689). Similarly, the percentages of seizure-free patients with no antiepileptic drugs at last evaluation were not different between groups (P=0.817). In logistic regression analysis, left HS (P=0.001; OR=4.166 [95% CI=1.86-9.34]) and age at epilepsy onset ≤2 years (P=0.047; OR=3.885 [95% CI=1.86-17.50]) were independently associated with risk of having GWMA. CONCLUSION: GWMA are frequent findings in patients with TLE and HS, and may help lateralize the epileptogenic zone. Our data support the hypothesis that GWMA are caused by seizure-related insults during the critical period of cerebral myelination. GWMA did not influence the postoperative seizure outcome of patients with TLE and HS, even after an extended duration of post-surgical follow-up.

Sonographic description and classification of tendinous involvement in relation to tophi in chronic tophaceous gout.

OBJECTIVE: To describe and classify the varied ultrasound features of tendinous involvement in relation to tophi in chronic tophaceous gout so that they are better recognised. METHODS: Ultrasound images of 138 affected areas from 31 patients with chronic tophaceous gout were analysed using high-quality broadband linear transducers. The relationship between tendon and tophi was classified, and the inter-observer agreement regarding classification was analysed. RESULTS: Tophi envelopment in the tendon was the most frequent characteristic (45%) followed by no relationship between tophi and tendon (41%), tophi at the insertion site of the tendon (7%), extrinsic compression (6%) and tophi within the tendon (1%). The inter-observer concordance on classification of the relationship between tophi and tendon was measured using McNemar's test with P < 0.001 (χ(2) = 30.0, degree of freedom = 9) and kappa test = 0.627 (P < 0.001), indicating substantial inter-observer concordance. CONCLUSION: Tophi generally envelope the tendon or there is no relationship between them. Tophi can also be found at the insertion site of the tendon, cause extrinsic compression or be located inside the tendon. There is substantial inter-observer agreement for ultrasound classification of tendon involvement by tophi. This study contributes to diagnostic elucidation and shows the diverse characteristic forms of tendon involvement by tophi.