Objective To investigate the clinical value of 320 slice CT and high-frequency ultrasound in the diagnosis of gouty arthritis (GA) in 63 cases. Methods A total of 63 arthritic patients treated in department of rheumatology in our hospital between May 2013 to June 2015 were selected for the study and were given high-frequency ultrasound and 320 slice CT respectively. The sensitivity, specificity, false negative rate, false positive rate, positive predictive value and negative predictive value of the two methods in the diagnosis of GA were compared, and the consistency of the two methods in the diagnosis of GA was analyzed. Results There were statistically significant differences between high-frequency ultrasound and 320 slice CT in the sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value in the diagnosis of GA (73.91% VS 86.96%, 82.35% VS 88.24%, 17.65% VS 11.76%, 26.09% VS 13.04%, 91.89% VS 95.24%, 53.85% VS 71.43%) (P<0.05). The two methods were compared with the clinical diagnostic criteria for the diagnosis of GA, and the ROC curve was drawn. The area under ROC curve of high-frequency ultrasound was 0.79, and the area of 320 slice CT was 0.92 (P<0.05). The Kappa values of the two methods in the diagnosis of uric acid crystals, bone defects and joint effusion were 0.578, 0.892 and 0.824, respectively (P<0.05). Conclusion The sensitivity and specificity of 320 slice CT and ultrasound are high in the diagnosis of GA. The sensitivity of 320 slice CT is higher than high-frequency ultrasound in the detection of uric acid crystals and it show the bone destruction and urate deposition better.