Figure 9b. Tophaceous gout involving the intermetatarsal and tarsometatarsal region of the foot in a 56-year-old man with hyperuricemia who presented with foot pain and swelling. (a) Axial T1-weighted MR image shows low-signal-intensity tophi (long arrows) and adjacent periarticular erosions with characteristic overhanging edges (short arrows). The joint spaces are preserved, as is typical in gout. (b, c) Coronal proton-density-weighted (b) and T2-weighted (c) MR images obtained at the level of the tarsometatarsal joint reveal erosions (short arrows) and low-signal-intensity tophi (long arrows). (Fig 9b and 9c reprinted, with permission, from reference 24.) (d) Gadolinium-enhanced fat-suppressed T1-weighted MR image shows increased contrast enhancement of the tophi (arrows) and juxta-articular bone.