Detection of calcium pyrophosphate dihydrate crystals in knee meniscus by dual-energy computed tomography

Abstract

BackgroundCalcium pyrophosphate dihydrate (CPPD) crystals are commonly observed in osteoarthritic joints. The aim of our study was to investigate the efficacy of a dual-energy computed tomography (DECT) for detecting CPPD crystals in knee meniscus.MethodsTwenty-six patients undergoing primary total knee arthroplasty were included in the study. Radiographs of knee joint and synovial fluid specimens were analyzed for the presence of CPPD crystals. Meniscus extracted during surgery was scanned using DECT. Sensitivity and specificity of DECT and radiograph for detecting CPPD crystals were calculated against a reference standard (polarizing light microscopy of synovial fluid aspirate). Meniscus in which CPPD crystals were suspected with DECT was further examined to confirm the crystals using a polarized microscopy.ResultsCPPD crystals in synovial fluid were observed in 9 (36%) patients. The sensitivity and specificity of DECT in the detection of CPPD crystals, against microscopic identification, were 77.8 and 93.8%, respectively. The sensitivity and specificity of conventional radiography in the detection of CPPD crystals were 44.4 and 100%, respectively. DECT was able to detect the area where CPPD crystals were deposited in the meniscus.ConclusionDECT provides good diagnostic sensitivity and specificity for detection of CPPD crystals in knee meniscus as well as spatial information about CPPD crystals. DECT is currently a research tool, but we believe that DECT can be a useful instrument to diagnose CPPD deposition disease, especially for the regions where aspiration is difficult to be performed such as pubic symphysis, atlantoaxial joint, interphalangeal joint.

Clinical Utility of Multi‐Energy Spectral Photon‐Counting Computed Tomography in Crystal Arthritis

“…Other imaging modalities such as ultrasound and dual‐energy computed tomography (DECT) are being increasingly used to aid in the diagnosis of gout (). A recent study showed that DECT can also detect CPP crystal deposits ex vivo, with a reported sensitivity and specificity of 78% and 94%, respectively (). However, the role of these imaging techniques in other crystal deposition diseases is less well defined, and they cannot easily distinguish between different calcium crystals.…”

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].…”

Ultrasonography, an operator-dependent modality versus dual-energy computed tomography (DECT) in the detection of chondrocalcinosis: with regard to Tanikawa et al.’s study

“…I read with interest the article by Tanikawa et al [ 1 ] that appeared recently in the Journal of Orthopedics Surgery Research. Greatly, this is an interesting paper about the role of dual-energy computed tomography (DECT) in the detection of chondrocalcinosis.…”

“…Tanikawa et al [ 1 ], however, did not mention in their article about the availability of ultrasound and the possibility to scan several joints with lower expenditures at the same visit. On the other hand, while this paper has appeared, mounts of publications demonstrate that ultrasound is an excellent modality in the diagnosis of chondrocalcinosis.…”