Journal of Clinical Images and Medical Case Reports

ISSN 2766-7820
Clinical Image - Open Access, Volume 3

Clinical images: Cinematic rendering of tophaceous gout

Hannah S Recht1*; Elliot K Fishman2

1Northwestern University Feinberg School of Medicine, Department of Radiology, 676 North St. Clair Street, Suite 800. Chicago, IL 60611, USA.

2Johns Hopkins University School of Medicine, The Russell H Morgan Department of Radiology and Radiological Science, 601 North Caroline Street, JHOC 4260 C, Baltimore, Maryland 21287, USA.

*Corresponding Author : Hannah S Recht, MD,
Northwestern University Feinberg School of Medicine, Department of Radiology, 676 North St. Clair Street, Suite 800, Chicago, IL 60611, USA. Tel: (216) – 570-2406;
Email: [email protected]
ORCID ID: 0000-0003-2697-3831

Received : May 24, 2022

Accepted : Jun 24, 2022

Published : Jul 01, 2022

Archived :

Copyright : © Recht HS (2022).

Keywords: Three-dimensional imaging; Gout; Musculoskeletal radiology

Citation: Recht HS, Fishman EK. Clinical images: Cinematic rendering of tophaceous gout. J Clin Images Med Case Rep. 2022; 3(7): 1922.


A 77 year-old-man with a complex medical history, notable for multiple myeloma in remission and gout, presented for noncontrast Computed Tomography (CT) of the right upper extremity using dual energy technique, from which cinematic rendered images were created (Figure 1). The cinematic rendered images provide a unique, photorealistic, three-dimensional representation of the extensive tophi and their relationship to the adjacent structures within the hand.

Gout is a common inflammatory arthropathy caused by the deposition of monosodium urate crystals. Multiple advanced imaging techniques have been utilized in the evaluation of gout, including dual-energy CT [1,2]. However cinematic rendering, through its use of a complex global lighting model, has the unique ability to provide three-dimensional photorealistic images from volumetric CT datasets. Cinematic rendering can help improve visualization of complex anatomy and pathology, particularly for those without formal training. The photorealistic images created by this novel technique may help increase patient understanding and improve communication between patients and clinicians.

Figure 1A: Coronal cinematic rendered image provides improved global visualization of the extensive periarticular monosodium urate crystal deposition, with prominent involvement at the metacarpophalangeal joints (white arrow) and proximal interphalangeal joints (yellow arrow).

Figure 1B: Coronal cinematic rendered reconstruction utilizing different parameters demonstrates an excellent view of the relationship of the flexor tendons to the monosodium urate crystals, particularly at the level of the carpometacarpal and intercarpal joints (yellow arrows).


Funding information: Hannah S Recht: None.

Elliot K Fishman: Receives grant funding from GE Healthcare and Siemens, and is a founder and stockholder, HipGraphics.

Declarations of interest: None


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