Sensitivity and Reproducibility of Ultrasonography in Calcium Pyrophosphate Crystal Deposition in Knee Cartilage: A Cross-sectional Study

Ottaviani, Sébastien; Juge, Pierre-Antoine; Aubrun, Aurore; Palazzo, Élisabeth; Dieudé, Philippe

doi:10.3899/jrheum.141067

Cited by 22 publications

(17 citation statements)

References 19 publications

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“…In addition to the subgroups described above, we also compared the test characteristics of US in patients with MSU-positive gout with the subgroup of controls with CPDD. CPDD is associated with similar US findings (12,13,(16)(17)(18)(19). In our study, the specificity of US for gout remained .80%.…”

Section: Discussionsupporting

confidence: 80%

Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study: Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard

Ogdie

Taylor

Neogi

et al. 2017

Arthritis & Rheumatology

115

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Objectives To examine the performance of ultrasound for the diagnosis of gout using presence of monosodium urate (MSU) crystals as the gold standard. Methods We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multi-center observational cross-sectional study of consecutive subjects with at least one swollen joint who conceivably may have gout. All subjects underwent arthrocentesis; cases were subjects with MSU crystal confirmation. Rheumatologists or radiologists, blinded to the results of the MSU crystal analysis, performed ultrasound on one or more clinically affected joints. Ultrasound findings of interest were: double contour sign (DCS), tophus, and ‘snowstorm’ appearance. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. Multivariable logistic regression models were used to examine factors associated with positive ultrasound results among subjects with gout. Results Ultrasound was performed in 824 subjects (416 cases and 408 controls). The sensitivity, specificity, PPV and NPV for the presence of any one of the features were 76.9%, 84.3%, 83.3% and 78.1% respectively. Sensitivity was higher among subjects with disease ≥2 years duration and among subjects with subcutaneous nodules on exam (suspected tophus). Associations with a positive ultrasound finding included suspected clinical tophus (odds ratio 4.77; 95% CI 2.23–10.21), any abnormal plain film radiograph (4.68; 2.68–8.17) and serum urate (1.31; 1.06–1.62). Conclusions Ultrasound features of MSU crystal deposition had high specificity and high positive predictive value but more limited sensitivity for early gout. The specificity remained high in subjects with early disease and without clinical signs of tophi.

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Section: Discussionsupporting

confidence: 80%

Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study: Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard

Ogdie

Taylor

Neogi

et al. 2017

Arthritis & Rheumatology

115

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“…In the present study, US findings indicative of CPP crystal deposits were more frequently detected at the acetabular labrum fibrocartilage than at the femoral head's hyaline cartilage. This result is consistent with what had been shown at knee level in previous US studies where CPP crystal deposits were more frequently found at the meniscal fibrocartilage than at the femoral condyles' hyaline cartilage, with the exception of 1 study in which US calcifications were more frequently detected at the femoral condyles' hyaline cartilage than at the meniscal fibrocartilage .…”

Section: Discussionsupporting

confidence: 92%

“…The opportunity to consider the hip as a sentinel region for the detection of CPP crystal deposits even in the absence of knee involvement is clinically relevant, especially in patients with joint pain of unknown origin. US has gained a well‐defined role in the diagnosis of CPPD, having shown a greater or equal sensitivity and comparable specificity to CR in the detection of CPP crystal aggregates . However, to the best of our knowledge, there is no study that has compared the diagnostic accuracy of US and CR in the evaluation of CPP crystal deposits at the hip joint in patients with CPPD.…”

Section: Introductionmentioning

confidence: 99%

Hip Involvement in Patients With Calcium Pyrophosphate Deposition Disease: Potential and Limits of Musculoskeletal Ultrasound

Matteo

Filippucci

Cipolletta

et al. 2019

Arthritis Care & Research

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Objective. To preliminarily explore the diagnostic potential of ultrasound (US) in detecting calcium pyrophosphate (CPP) crystal deposits at the hip joint in a cohort of patients with CPP deposition disease (CPPD) who were previously evaluated by conventional radiography (CR) and to assess the sensitivity and specificity as well as the agreement between US and CR in the evaluation of hip CPP crystal deposits.Methods. Fifty consecutive patients with definite CPPD and 40 age/sex/body mass index-matched disease control subjects who had undergone hip CR within the previous 6 months were enrolled. Bilateral hip US examination was carried out to assess the presence of CCP crystal deposits at the acetabular labrum fibrocartilage and at the femoral head's hyaline cartilage. Two independent radiologists evaluated the presence of hip CPP crystal deposits on CR in both groups.Results. US findings indicative of CPP crystal deposits were found in at least 1 hip in 45 of 50 patients with CPPD (90.0%) and in 73 of 100 hips (73.0%). CPP crystal deposits were more frequently found at the acetabular labrum fibrocartilage than at the femoral head's hyaline cartilage (72% and 17% of the hips in patients with CPPD, respectively).

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“…CPPD deposits were slightly more common in our cohort (37.5% in HH-WA and 61.5% in HH-A) than in previous cohorts of patients with HH (30–50%) [ 7 ]. We explain this by the greater sensitivity of ultrasound to detect CPPD as compared to other methods such as radiography or synovial fluid aspiration [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound verified inflammation and structural damage in patients with hereditary haemochromatosis-related arthropathy

et al. 2017

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BackgroundChronic arthropathy occurs in approximately two thirds of patients with hereditary haemochromatosis (HH). The aim was to study inflammatory and structural lesions in patients with HH with (HH-A) and without arthropathy (HH-WA) using ultrasonography.MethodsThis was a cross-sectional study of 26 patients with HH-A, 24 with HH-WA and 37 with hand osteoarthritis (HOA). Clinical examination was performed in 68 joints, and we retrieved data on hand function, pain and global disease activity (all using a visual analogue scale (VAS)), morning stiffness and ferritin levels. Standard x-ray and ultrasound were conducted in 36 joints (hands, hips, knees and ankles), and we graded grey scale synovitis (GSS), power Doppler ultrasound (PD), osteophytes, erosions, tenosynovitis and cartilage damage semi-quantitatively in accordance with prior publications.ResultsUltrasound revealed a high proportion of inflammatory changes in HH-A; GSS was found in 96.2% and PD signals in 80.8% of patients (median GSS score 9, PD score 2.5). The frequency of these findings was similar in HOA. Inflammation was also common in HH-WA, yielding GSS in 83.3% and PD signals in 50.0% of patients. Cartilage damage was most prominent in HH-A as compared to HH-WA and HOA (median scores 11.0, 2.5 and 2.0, respectively). The prevalence and extent of erosions and osteophytes were similar in all groups. None of the ultrasound scores was associated with pain or function; GSS, PD, osteophyte and cartilage scores correlated with x-ray-verified structural damage.ConclusionA high prevalence of ultrasound-verified inflammation and cartilage damage was found in HH-A, and to a lesser extent in HH-WA. These findings were associated with x-ray-verified damage but not with clinical scores of pain and function.

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Sensitivity and Reproducibility of Ultrasonography in Calcium Pyrophosphate Crystal Deposition in Knee Cartilage: A Cross-sectional Study

Abstract: US of knees is more sensitive than radiography for CPPD diagnosis.

Cited by 22 publications

References 19 publications

Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study: Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard

Performance of Ultrasound in the Diagnosis of Gout in a Multicenter Study: Comparison With Monosodium Urate Monohydrate Crystal Analysis as the Gold Standard

Hip Involvement in Patients With Calcium Pyrophosphate Deposition Disease: Potential and Limits of Musculoskeletal Ultrasound

Ultrasound verified inflammation and structural damage in patients with hereditary haemochromatosis-related arthropathy

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