Abstract: Objective To determine the diagnostic value of ultrasound imaging in chronic gouty arthritis. Methods Ultrasound imaging of 32 patients with chronic gouty arthritis were compared with those of 36 patients with non-gouty joint diseases. A logistic model was obtained to establish the associations between ultrasound appereances and gouty arthritis. Receiver operator characteristic (ROC) curve was constructed to evaluate the performance of the logistic model. Results A double contour sign of articular cartilage, a snowstorm appearance of the joint fluid, and a hyperecho around the periarticular tendon had diagnostic value for chronic gouty arthritis. According to the logistic regression analysis, the accuracy of predicting chronic gouty arthritis was 95.59% (65/68), and the area under curve of ROC was 0.987±0.011 (P<0.05). Conclusion A double contour sign of articular cartilage, a snowstorm appearance of the joint fluid, and a hyperecho around the periarticular tendon have diagnostic value. The combination of these appearances can improve diagnosis of chronic gouty arthritis.