Diagnostic value of ultrasound in calcium pyrophosphate deposition disease of the knee joint

Abstract

Objective: To assess the diagnostic performance of ultrasound (US) for calcium pyrophosphate deposition (CPPD) at the level of menisci, hyaline cartilage (HC), tendons, and synovial fluid (SF) of the knee, and to examine inter-and intra-observer reliability. Design: We consecutively included patients with knee effusion over a 2-year period (43 patients with CPPD and 131 controls). All patients underwent SF analysis, conventional radiography (CR), and US examination using the Outcome Measures in Rheumatology (OMERACT) definition of the US characteristics of CPPD. Two independent operators performed the US, and inter-observer agreement was calculated. Intra-observer agreement was examined with static images obtained for all enrolled patients. Results: US revealed calcium pyrophosphate (CPP) deposits in menisci, HC, and tendon more frequently in patients with CPPD than in control patients. The presence of US CPP deposits in SF was not significantly different between the two groups. Combined US evaluation of the three components (menisci, HC, and tendon) showed the best diagnostic performance. The sensitivity and specificity for US evaluation of the three components were 74.4% and 77.1%, respectively, while for CR evaluation, the sensitivity and specificity were 44.2% and 96.9%, respectively. Inter-and intra-observer agreement were excellent for medial (k ¼ 0.930, 0.972) and lateral menisci (k ¼ 0.905, 0.942), HC (k ¼ 0.844, 0.957), and SF (k ¼ 0.817, 0.925). Tendon showed fair inter-observer (k ¼ 0.532) and good intra-observer reliability (k ¼ 0.788). Conclusions: Based on the OMERACT definition, US demonstrated better diagnostic capacity than CR to diagnose CPPD, with excellent reliability. Combined evaluation of menisci, HC, and tendon showed the best diagnostic accuracy.

Age-related features of calcium pyrophosphate deposition disease

“…Так, в проводимых до настоящего времени популяционных исследованиях в качестве основного классификационного критерия использовались рентгенологические признаки ХК лучезапястных суставов, который, во-первых, не тождествен БДПК, а во-вторых, имеет довольно низкую чувствительность [0,29; 95% доверительный интервал (ДИ) 0,05-0,62] и специфичность (0,20; 95% ДИ 0,15-0,55) [13]. В целом чувствительность рентгенологически выявляемого ХК составляет примерно 40%, если брать в качестве эталона наличие кристаллов ПФК в СЖ [13][14][15][16]. Как следствие, эта оценка весьма приблизительна, поскольку 25-50% пациентов, у которых в СЖ выявляются кристаллы ПФК, не имеют рентгеновских признаков ХК коленных суставов [17].…”

Anatomy and ultrasound imaging of the tibial collateral ligament: A narrative review

“…The peripheral portion of the MM must be carefully evaluated during the sonographic assessment of the TCL because pathological conditions involving the outer third of the medial fibrocartilage can clinically mimick ligamentous disorders. Parameniscal cysts, peripheral delaminations of the fibrocartilage (Dai et al, 2015; Dong et al, 2018), intra‐meniscal calcifications (Lee et al, 2019), meniscal extrusions (Chiba et al, 2020) and meniscal fragments migrating inside the superior/inferior parameniscal recesses (Ricci et al, 2020; 39: 805–810) are the most frequent conditions observed in clinical practice (Figure 7). As a side note, dynamic assessment may also be integrated to promptly evaluate hypo/hypermobility of the fibrocartilage (Video S12) (Karpinski et al, 2019; Reisner et al, 2020).…”

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

“…Background US detection and quantification of inflammatory findings in the knee have been validated using MRI [129] and histology [130]. US has also shown great value in the detection of crystal deposition in several structures of the knee such as the articular cartilage, menisci, and tendons [131][132][133]. In OA, the assessment of meniscal protrusion, articular cartilage degeneration, synovitis, osteophytes, and Baker's cysts (popliteal cyst) are the main uses of US.…”