Ultrasound Detection of Cartilage Calcification at Knee Level in Calcium Pyrophosphate Deposition Disease

Abstract

Objective. To determine the sensitivity, specificity, and accuracy of ultrasound (US) in the detection of cartilage calcification at knee level in patients with calcium pyrophosphate deposition disease (CPDD) and to assess the interobserver reliability. Methods. Seventy-four CPDD patients and 83 controls with other chronic arthritis were included. All patients underwent a clinical examination, synovial fluid analysis, and radiographic assessment of the knee. US examinations were performed in order to detect hyperechoic spots within the hyaline cartilage layer and hyperechoic areas within the meniscal fibrocartilage. Twenty patients were assessed by 2 operators in order to calculate the interobserver reliability. Results. A total of 314 knees in 157 patients (74 with CPDD, 19 with rheumatoid arthritis, 17 with spondyloarthritis, 32 with osteoarthritis, and 15 with gout) were assessed. In the 74 patients with CPDD, hyaline cartilage spots were detected by US in at least 1 knee in 44 patients (59.5%), whereas radiography detected hyaline cartilage spots in 34 patients (45.9%) (P < 0.001). Meniscal fibrocartilage calcifications were detected by US in 67 of the 74 CPDD patients (90.5%), whereas conventional radiography detected calcifications in 62 patients (83.7%) (P ‫؍‬ 0.011). The criterion validity expressed as percentage of sensitivity, specificity, and accuracy of US in the detection of articular cartilage calcification was high. Both kappa values and overall agreement percentages showed moderate to excellent agreement. Conclusion. US is an accurate and reliable imaging technique in the detection of articular cartilage calcification at knee level in patients with CPDD.

The association between vitamin K status and knee osteoarthritis features in older adults: The Health, Aging and Body Composition Study

“…We hypothesized higher plasma (dp)ucMGP (reflective of lower vitamin K status) would be associated with worse articular cartilage and meniscal damage because those joint tissues are susceptible to calcium deposition and mineralization (31). Higher (dp)ucMGP was associated with higher odds of meniscal damage cross-sectionally, but it was not associated with articular cartilage damage.…”

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

“…To date, radiography is the main imaging modality used to detect CPPD 4,5 . US appears to be highly specific and sensitive in detecting CPPD 8,9,10,11,12,13,14 , and European League Against Rheumatism (EULAR) recommendations for CPPD highlighted its utility for the diagnosis of CPPD 3 . US appears to be highly specific and sensitive in detecting CPPD 8,9,10,11,12,13,14 , and European League Against Rheumatism (EULAR) recommendations for CPPD highlighted its utility for the diagnosis of CPPD 3 .…”

Impact of systematic ultrasound of the knee on the rheumatologist’s clinical decision in patients consulting for knee pain

“…Systematic US, as a complement to the radio-clinical examination, seems to be more interesting in crystal arthropathies [7,25] even if the gold standard for the diagnosis remains the identification of CPP or monosodium urate crystals in synovial fluid by polarized light microscopy. In the present study, seven clinical diagnoses of knee OA flares were modified to CPPD after the US examination, thus underlining the sensitivity of US [8]. However, six clinical diagnoses of CPPD were ruled out by the systematic US, suggesting a negative predictive value of US [9] but without additional synovial fluid aspiration to confirm the absence of CPP crystal.…”

“…Features suggestive of gout were the presence of the double contour sign (hyperechogenic irregular band over the cartilaginous interface) and tophus appearance (hypoechogenic to hyperechogenic nonhomogenous mass surrounded by a small anechoic rim) [19]. Hyperechogenic band or spots within the femoral hyaline cartilage and hyperechogenic meniscal calcification were US findings indicative of CPPD knee disease [7,8].…”

“…It can also be useful in cases of pain in patients with a prosthesis or osteosynthesis devices because there are no major ultrasound artifacts [6]. More recently, certain studies have shown the interest of US in crystal-related diseases of the knee [7][8][9] and guided procedures [10,11]. However, the diagnostic accuracy can be different between experts and non-experts in musculoskeletal ultrasound [12] and Abstract This clinical practice study aimed to determine whether the results of systematic US in patients with knee pain modified the rheumatologist's choices concerning diagnostic management and therapy.…”