PURPOSE: To investigate the correlation among semi-quantitative scoring of blood flow by superb microvascular imaging (SMI), hypersensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and serum uric acid (SUA) levels in different gout duration. METHODS: 103 patients (total 157 affected joints) with clinically confirmed acute gout attack from January 2021 to May 2022 were performed with laboratory tests (hs-CRP, ESR, SUA), routine joint ultrasound scanning, along with semi-quantitative scoring of SMI, and correlations between which were analyzed. RESULTS: Statistically significant differences were found in semi-quantitative scoring of SMI in the affected joints between different disease duration. The differences between SMI scoring in gouty tophi, synovial hyperplasia, and the levels of different hs-CRP and ESR subgroups of the affected joints were statistically significant (p <
0.05). R values between SMI scoring in synovial hyperplasia as well as gouty tophi and hs-CRP levels were 0.711 and 0.579, respectively, and those of ESR were 0.430 and 0.418, respectively, while those of SUA levels were -0.227 and 0.120, respectively. CONCLUSION: With a prolonged progression of gout, hs-CRP and ESR levels amplify, along with a concurrent intensification in the SMI scorings of blood flow signals in the affected joints (grades 2 and 3). In the acute gout attack, SMI blood flow scoring showed a moderate correlation to hs-CRP, a low correlation to ESR, and no correlation to SUA, among which the best correlation was found between SMI scoring and hs-CRP levels in the synovial hyperplasia.