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Vitamin B12 levels are usually tested with a blood serum test, and values below approximately 170–250 picogram per milliliter in adults are considered signs of deficiencies

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Figure 17: Large Tophus Seen as Soft Tissue Mass at the Elbow ) but in special cases, such as when gout needs to be separated from infection or tumor, magnetic resonance imaging (MRI) ( Figure 18: MRI of the Knee Showing Gouty Soft Tissue Mass and Erosion of the Kneecap ) or ultrasound ( Figure 19: Power Doppler Study Showing Gouty Inflammation at the Base of the 1st Toe ) will be helpful