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What is the most likely diagnosis?
Based on characteristic most common location and MR features, gout is the diagnosis.
If it is a crystal deposition disease, which crystal is deposited here?
Monosodium urate (negatively bifringent crystals). Pseudogout has calcium pyrophospate dihydrate (CPPD), which is positively bifringent.
Do all hyperuricemic patients develop gout? Or do all gout patients have hyperuricemia?
No, in fact, only a small percentage of hyperuricemia patients proceed to have gout. But, yes, almost all gout patients will have either hyperuricemia and/or increased serum uric acid levels.
Characteristic T1 hypointense periarticular soft tissue rim is seen at 1st metatarsophalangeal joint, suggesting tophus.