Comparison of ultrasound attenuation by calcium pyrophosphate, hydroxyapatite and monosodium urate crystals: a proof-of-concept study

Filippou, Georgios; Pacini, Giovanni; Sirotti, Silvia; Zadory, Matthias; Carboni, Davide; Damiani, Arianna; Fiorentini, Elisa; Cipolletta, Edoardo; Filippucci, Emilio; Froehlich, Johannes M.; Puttini, Piercarlo Sarzi; Becce, Fabio

doi:10.1136/annrheumdis-2022-222316

Cited by 13 publications

(10 citation statements)

References 6 publications

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“…As discussed, according to the OMERACT definitions, CPP deposits appear hyperechogenic, similarly to the bone profile, and typically do not create posterior acoustic shadowing. This last aspect has been recently demonstrated in a proof-of-concept study involving the scanning of phantoms with increasing concentrations of CPP crystals, and it was found that these crystals did not generate posterior shadowing, in contrast to other calcium crystals, which exhibited beam attenuation at increasing concentrations [33]. The exact explanation of this phenomenon remains unclear, but it is probably related to the three-dimensional structure of the crystals, which may result in lower acoustic impedance and thus less attenuation of the ultrasound beam.…”

Section: General Considerationsmentioning

confidence: 86%

Optimizing the Use of Ultrasound in Calcium Pyrophosphate Deposition (CPPD): A Review from the Ground Up

Filippou,

Sirotti,

Cipolletta

et al. 2024

GUCDD

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Ultrasound is a pivotal exam in calcium pyrophosphate deposition (CPPD) identification. It has been demonstrated to be feasible, accurate, and reliable for CPPD diagnosis. Even if standardized definitions and a scoring system for CPPD have been established by the OMERACT ultrasound working group, ultrasound is still considered one of the most operator-dependent techniques. This is because in ultrasound, both the acquisition and the interpretation phases of the diagnostic process are in the hands of one operator and are performed simultaneously, in contrast to what happens with other imaging exams, where the acquisition process is standardized and independent from the interpretation process. Therefore, the scanning technique and machine setting acquire a central role, almost as important as the interpretation of the images, as erroneous scanning may lead to interpretative mistakes. In this review, we will delve into the appearance of CPPD on ultrasound, based on the latest research findings, passing through its pathogenesis, and focusing on machine settings and ultrasound scanning techniques, providing some tips and tricks to facilitate accurate CPPD recognition in the most frequently affected sites.

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Section: General Considerationsmentioning

confidence: 86%

Optimizing the Use of Ultrasound in Calcium Pyrophosphate Deposition (CPPD): A Review from the Ground Up

Filippou,

Sirotti,

Cipolletta

et al. 2024

GUCDD

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“…Recent evidence has suggested that US may have the ability to differentiate between different types of crystal deposition, thanks to their different physical characteristics. In a pilot study on phantoms with different type of crystals in increasing concentrations [6], CPP crystals were the only ones not creating posterior shadowing even in high concentrations, when compared to uric acid and hydroxyapatite crystals. Further, the anatomical location and some technical tricks could allow to differentiate between CPP and uric acid crystals.…”

Section: Technical Aspects Regarding Ultrasonography Application In C...mentioning

confidence: 92%

How can ultrasonography help in the management of CPPD? From diagnosis to clinical subset identification

Filippou

Sirotti

2023

Current Opinion in Rheumatology

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Purpose of reviewClinical manifestations of calcium pyrophosphate deposition (CPPD) disease are quite heterogeneous, ranging from asymptomatic presentation to severe forms of arthritis. In recent years, imaging, particularly ultrasound (US) has gained a central role for the diagnosis of CPPD. However, many questions are still open. Aim of this review is to present how US could be a key tool in the diagnosis and assessment of CPPD and for the identification of subsets of the disease.Recent findingsawareness and research interest around CPPD is increasing in the recent years, as several international taskforces are working on the validation of outcome measures and classification criteria for CPPD, but many pieces of the puzzle are still missing. Recent studies demonstrated that CPPD is an underdiagnosed disease, frequently misdiagnosed as rheumatoid arthritis or polymyalgia rheumatica. US has been increasingly used in the past decade for the diagnosis of CPPD and US definitions have been validated by the OMERACT US working group in the recent years, making of US a valuable tool for diagnosis.SummaryThe most challenging aspects of CPPD are the differential diagnosis with other form of arthritis of the elderly, and the classification of patients in clinical subsets. In this review, we will present the available data for the use of US in the diagnosis of CPPD and we will provide a mainly experienced-based approach to the potential role of the technique in differential diagnosis and phenotypization of patients.

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“…Compared to calcium pyrophosphate (CPP) crystals, MSU deposits may have variable echogenicity (from hypoechoic to hyperechoic) and are frequently inhomogeneous [11,16,18,19]. They may generate posterior acoustic shadowing [16,18,20]. This aspect may contribute to differentiating MSU deposits from other hyperechoic structures and CPP crystal deposits.…”

Section: Machine Setting Optimisation For Crystal Visualisationmentioning

confidence: 99%

Optimising the Use of Ultrasound in Gout: A Review from the Ground Up

Filippucci,

Cipolletta,

Sirotti

et al. 2024

GUCDD

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The use of ultrasonography (US) has considerable potential for the diagnosis and monitoring of gout due to its capacity to detect monosodium urate deposits. In the last decade, a critical amount of scientific data has become available. Consensus-based definitions for ultrasonographic elementary lesions in gout have been developed, tested, and validated, as well as a semiquantitative scoring system for their quantification. Many scanning protocols have been proposed in different clinical scenarios. In this review, we formulate a set of practical suggestions for the use of the US in daily practice. We discuss the current knowledge to indicate which joints and structures are to be scanned and which elementary findings are to be evaluated according to the clinical scenario. While for some clinical settings, a quite definite scanning protocol can be indicated, others still need to be further investigated, and how to obtain the best out of the US is still entrusted to the individual experience.

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Comparison of ultrasound attenuation by calcium pyrophosphate, hydroxyapatite and monosodium urate crystals: a proof-of-concept study

Cited by 13 publications

References 6 publications

Optimizing the Use of Ultrasound in Calcium Pyrophosphate Deposition (CPPD): A Review from the Ground Up

Optimizing the Use of Ultrasound in Calcium Pyrophosphate Deposition (CPPD): A Review from the Ground Up

How can ultrasonography help in the management of CPPD? From diagnosis to clinical subset identification

Optimising the Use of Ultrasound in Gout: A Review from the Ground Up

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