Abstract: ob＜x＞jective To study the manifestations of high-frequency ultrasound in patients with acute gouty knee arthritis, and to explore the application value of high-frequency ultrasound in the diagnosis of acute gouty knee arthritis. Methods A retrospective analysis of the high-frequency ultrasonographic features of 70 joints in 50 clinically diagnosed patients with acute gouty knee arthritis and 72 joints in 56 patients with non-gouty knee arthritis, including: joint effusion , Synovial thickening, synovial blood flow signal, strong echo light spot, tophi, "double line sign" of femoral trochlear cartilage, bone erosion and hyperechoic aggregates in tendons. Results There were significant differences between acute gouty knee arthritis group and non gouty knee arthritis group in "double line" sign, strong echo light spot, gout stone and hyperechoic aggregate in tendon (P < 0.05). In the diagnosis of acute gouty knee arthritis, the sensitivity of "double line" sign, hyperechoic light spot, gout stone and hyperechoic aggregates in tendons were 88.6%, 57.1%, 57.1% and 32.9%, the specificity were 97.2%, 83.3%, 98.6% and 93.1%, the positive predictive values were 96.9%, 76.9%, 93.0% and 82.1%, and the negative predictive values were 89.7%, 66.7%, 69.7% and 58.8%,respectively. Conclusion High frequency ultrasound has important value in the diagnosis of acute gouty knee arthritis