The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis

Cipolletta, Edoardo; Filippou, Georgios; Scirè, Carlo Alberto; Matteo, Andrea Di; Battista, Jacopo Di; Salaffi, Fausto; Grassi, Walter; Filippucci, Emilio

doi:10.1016/j.joca.2021.01.007

Cited by 40 publications

(35 citation statements)

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“…However, most patients with calcifications of the intervertebral discs and articular cartilages are asymptomatic [ 5 ]. Conventional radiography and sonography are main imaging techniques for the diagnosis of peripheral CPPD and the computed tomography is commonly used to detect axial CPPD [ 6 , 7 ]. In the presented case series, we report 18 patients with calcification of cervical ligamentum flavum who required surgical treatment and finally were confirmed to suffer from CPPD deposition disease by pathologic diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Multilevel calcium pyrophosphate dihydrate deposition in cervical ligamentum flavum: clinical characteristics and imaging features

Lin

Chen³

et al. 2021

BMC Musculoskelet Disord

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Background Involvement in cervical ligamentum flavum is a rare manifestation of the calcium pyrophosphate dihydrate deposition disease. Only few cases of this condition have been reported. We revealed eighteen cases of CPPD in cervical ligamentum flavum that diagnosed at a single medical center. In our case series, clinical characteristics and magnetic resonance imaging findings of patients are described. Methods We retrospectively reviewed the medical charts and imaging studies of the eighteen patients with pseudogout attack of the cervical ligamentum flavum. In addition, we discussed the differences between this disease and ossification of ligamentum flavum in image manifestations. Results There were fourteen men and four women aged between 59 and 87 years. Diabetes mellitus and hypertension were the most common comorbidities. Myelopathy and neck pain were presented in most patients. C4–5 and C5–6 were attacked most frequently, and multiple- rather than single-level involvement could be observed in our series. “Acute on chronic phenomenon” was a specific magnetic resonance image finding in patients whose symptom durations were between 2 to 5 months. Compared to ossification of ligamentum flavum, calcium pyrophosphate dihydrate crystal deposition had different image signs, including morphology, side of the involved ligament, no continuity with the lamina, acute on chronic phenomenon, and presence of retro-odontoid mass. Conclusions Nodular calcifications in cervical ligamentum flavum raise highly suspicion for calcium pyrophosphate dihydrate deposition and must be diagnosed by histological examination and polarized light microscopy. This disease is different from ossification of ligamentum flavum, and it could be recognized by specific image features.

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Section: Introductionmentioning

confidence: 99%

Multilevel calcium pyrophosphate dihydrate deposition in cervical ligamentum flavum: clinical characteristics and imaging features

Lin

Chen³

et al. 2021

BMC Musculoskelet Disord

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“…ability and criterion validity with good results (13,18,19); while DECT has proven helpful in the diagnosis of gout, and emerging data suggest that it may be promising in calcium crystal recognition and differentiation as well (20,21). Nonetheless, SFA via compensated polarized light microscopy is still considered the gold standard for the identification and diagnosis of CPPD-related arthropathies (1).…”

Section: Original Papermentioning

confidence: 99%

Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group - CPPD subgroup

et al. 2021

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The aim of this study was to evaluate the accuracy of synovial fluid analysis in the identification of calcium pyrophosphate dihydrate crystals compared to microscopic analysis of joint tissues as the reference standard. This is an ancillary study of an international, multicentre cross-sectional study performed by the calcium pyrophosphate deposition disease (CPPD) subgroup of the OMERACT Ultrasound working group. Consecutive patients with knee osteoarthritis (OA) waiting for total knee replacement surgery were enrolled in the study from 2 participating centres in Mexico and Romania. During the surgical procedures, synovial fluid, menisci and hyaline cartilage were collected and analysed within 48 hours from surgery under transmitted light microscopy and compensated polarised light microscopy for the presence/absence of calcium pyrophosphate crystals. All slides were analysed by expert examiners on site, blinded to other findings. A dichotomic score (absence/ presence) was used for scoring both synovial fluid and tissues. Microscopic analysis of knee tissues was considered the gold standard. Sensitivity, specificity, accuracy, positive and negative predictive values of synovial fluid analysis in the identification of calcium pyrophosphate crystals were calculated. 15 patients (53% female, mean age 68 yo ± 8.4) with OA of grade 3 or 4 according to Kellgren-Lawrence scoring were enrolled. 12 patients (80%) were positive for calcium pyrophosphate crystals at the synovial fluid analysis and 14 (93%) at the tissue microscopic analysis. The overall diagnostic accuracy of synovial fluid analysis compared with histology for CPPD was 87%, with a sensitivity of 86% and a specificity of 100%, the positive predictive value was 100% and the negative predictive value was 33%. In conclusion synovial fluid analysis proved to be an accurate test for the identification of calcium pyrophosphate dihydrate crystals in patients with advanced OA.

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“…Diagnosis is based on conventional radiograph (CR) that has a sensitivity of 0.39–0.47 and specificity of 0.95–1 [ 23 – 25 ] and US imaging characterized by high sensitivity 0.85- 0.89 and specificity 0.87–0.9 [ 25 , 26 ]. CR shows the typical calcification associated with other features such as joint space narrowing, subchondral bone sclerosis, bone cysts and marked osteophytes [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, in fibrocartilage, hyaline cartilage and synovial fluid we have hyperechoic deposits without posterior shadowing, while tendon deposits appear like multiple linear hyperechoic structures [ 28 ]. Despite a little lower specificity, US has higher sensitivity and it is a non-invasive technique, therefore US imaging should be preferred to CR [ 25 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

The role of Interleukin-1 receptor antagonist as a treatment option in calcium pyrophosphate crystal deposition disease

et al. 2021

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Calcium Pyrophosphate Crystal Deposition (CPPD) disease is characterized by the deposition of calcium pyrophosphate crystals in the cartilage. In most cases, it can manifest as a subclinical condition named chondrocalcinosis, often revealed by joint x-ray examination. In other cases, deposition can cause flares of arthritis, known as acute CPP crystal arthritis. In the last few years, many pathogenic pathways have been discovered. Interleukin-1 (IL-1) plays a key role in the pathogenesis of CPPD disease, both as a mediator of inflammatory response to crystals and as a promoter of damage to articular cartilage. In this review, we investigated the role of IL-1R inhibitor, such as Anakinra, as an alternative to the various therapeutic strategies for CPPD disease, especially among patients resistant to traditional treatment with NSAIDs, corticosteroids and colchicine.

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The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis

Cited by 40 publications

References 64 publications

Multilevel calcium pyrophosphate dihydrate deposition in cervical ligamentum flavum: clinical characteristics and imaging features

Multilevel calcium pyrophosphate dihydrate deposition in cervical ligamentum flavum: clinical characteristics and imaging features

Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group - CPPD subgroup

The role of Interleukin-1 receptor antagonist as a treatment option in calcium pyrophosphate crystal deposition disease

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