ObjectiveTo analyze the diagnostic value of gemstone spectral CT-imaging for urate crystal in joints and circum-tissues in patients with gout. MethodsBetween June 2013 and March 2014, 28 patients with gout confirmed by clinical and laboratory examination were reviewed retrospectively. The patients with peripheral joints suspected urate crystal due to gout underwent gemstone spectral CT scan on spectrum scanning gemstone spectral imaging (GSI) mode. Images were processed with GSI Viewer software. The visualization and distribution of urate crystal were noted. ResultsUrate crystal deposition in peripheral joints, tendon and ligaments of 28 patients were clearly displayed in uric acid (calcium) base images with gemstone spectral CT. The density of urate crystal in uric acid (calcium) base image was higher than that in calcium (uric acid) base image. The position of urate crystal deposition included metatarsophalangeal joint in 23 cases (82%), ankle joint in 4 cases (14%), and knee joint in 2 cases (8%), respectively, in which multi-locum suffered in 1 case. ConclusionUrate crystal deposition can be well depicted by gemstone spectral CT-imaging, which provides a new diagnosing method for gout without trauma. Gemstone spectral CT-imaging was greatly helpful for differential diagnosis of single joint sore pain.