Elsevier

Joint Bone Spine

Volume 77, Issue 3, May 2010, Pages 218-221
Joint Bone Spine

Review
Ultrasonography in Chondrocalcinosis

https://doi.org/10.1016/j.jbspin.2009.12.001Get rights and content

Abstract

Ultrasonography can visualize calcific deposits within soft tissues. The appearance and location of the deposits distinguishes articular chondrocalcinosis from other crystal deposition diseases. The most common findings are hyperechoic dots or lines running parallel to the joint surface, hyperechoic images within fibrous cartilage (menisci and triangular fibrocartilage complex), and deposits within tendons (Achilles tendon). Studies found that ultrasonography was highly sensitive and specific for detecting calcifications, using calcium pyrophosphate dihydrate crystal detection in joint fluid as the reference standard. Good agreement has been demonstrated between radiographs and ultrasonography for the detection of calcifications. Thus, ultrasonography is valuable for diagnosing articular chondrocalcinosis via the detection of calcifications within the joint cartilage, fibrocartilage, and tendons. In addition, ultrasonography is a noninvasive, widely available, inexpensive investigation that requires no radiation exposure.

Introduction

Articular chondrocalcinosis is a common crystal deposition joint disease in which calcium pyrophosphate dihydrate (CPPD) crystals deposit within the joint cartilage and fibrocartilage. According to the criteria developed by Ryan and McCarty [1], the diagnosis of articular chondrocalcinosis requires visualization of calcific deposits on the plain radiographs and detection of CPPD crystals in the joint fluid. Ultrasonography is an innocuous, well-tolerated, inexpensive diagnostic investigation that requires no radiation exposure and that can detect calcific deposits within soft tissues [2].

Based on a literature review, we discuss the ultrasound features of CPPD crystals, the sensitivity and specificity of ultrasonography compared to crystal identification in joint fluid, and the level of agreement between radiography and ultrasonography. Finally, the ultrasound features of other crystal deposition diseases are reviewed.

Section snippets

Features of articular cartilage deposits

The joint cartilage is normally seen on ultrasound scans as two hyperechoic lines separated by a uniform echo-free zone [3] (Fig. 1). In a 1995 study, ultrasonography features found at the knee using a 7.5 MHz probe were compared in 28 patients (56 joints) meeting Ryan and McCarty criteria for articular chondrocalcinosis and in 46 normal controls [4]. In the patients, the joint cartilage was significantly thinner. Furthermore, in 43 (76.8%) of the joints, linear hyperechoic images running

Sensitivity and specificity of ultrasonography for diagnosing chondrocalcinosis versus joint fluid examination for CPPD crystals

In a 2002 study of 21 patients with chondrocalcinosis and 19 controls with knee osteoarthritis, both knees were examined using a Toshiba machine (5-, 7.5- and 10-MHz transducers) to scan the femoral condyles anteriorly and posteriorly [6]. Joint fluid was examined for CPPD crystals and radiographs were taken. Please check: based on the article, the reference standard was radiography not joint fluid, which was taken only in the event of pain. Ultrasonography had 89% sensitivity and 90%

Agreement between radiography and ultrasonography for detecting calcifications

Few studies evaluated agreement between radiography and ultrasonography. Of 11 patients with chondrocalcinosis diagnosed on the basis of CPPD crystals in joint fluid, 11 had calcifications by ultrasonography and nine by radiography [7]. Of the two patients with false-negative radiographs, one had a nodular hyperechoic deposit in the triangular fibrocartilage complex and the other had hyperechoic spots in the lateral meniscus. In a comparison of knee ultrasound findings in 28 patients with

Gout

The most characteristic finding is the double-contour sign produced by sodium urate crystal deposits at the surface of the hyaline cartilage [3], [12], [13]. CPPD crystal deposits, in contrast, are located within the cartilage. In acute gout, the joint fluid is echo-free during the first episode then becomes hypoechoic with hyperechoic aggregates of variable size and shape (snowstorm appearance) as further episodes occur.

Tophi are seen as irregular heterogeneous masses. They are usually located

Conclusion

Ultrasonography holds promise for diagnosing articular chondrocalcinosis. Both sensitivity and specificity are high for detecting CPPD deposits. The ultrasound appearance and location of CPPD deposits differentiate them from the deposits seen in other crystal-deposition diseases. CPPD deposits are linear or punctate hyperechoic images that are parallel to the joint surface (Fig. 2, Fig. 3). CPPD deposits may be found in fibrous cartilage (triangular fibrocartilage complex and menisci, Fig. 4),

Conflicts of interest

The authors have no conflicts of interest to declare.

References (14)

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    Another clinically useful lesson from the GOAL study was the finding that in the presence of metacarpophalangeal chondrocalcinosis more than 90% of participants had involvement elsewhere.45,46 Using ultrasonography (US), CPPD can be easily detected.47 In contrast with gout, the crystals commonly lie within the substance of the hyaline cartilage.

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