scholarly journals SAT0554 SONOGRAPHIC ASSESSMENT OF CALCIUM PYROPHOSPHATE DEPOSITION DISEASE AT WRIST. A FOCUS ON THE SCAPHO-LUNATE LIGAMENT.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1234.2-1235
Author(s):  
E. Cipolletta ◽  
G. Smerilli ◽  
R. Mashadi Mirza ◽  
A. DI Matteo ◽  
F. Salaffi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Imaging Techniques ◽  
Calcium Pyrophosphate ◽  
Scaphoid Bone ◽  
Lunate Bone ◽  
Calcium Pyrophosphate Deposition Disease ◽  
Dorsal Aspect ◽  
Deposition Disease ◽  
Extensor Compartment

Background:Only few articles evaluated the wrist in calcium pyrophosphate deposition disease (CPPD), although it is the second most frequent target of CPPD. Very recently, in a computed tomography (CT) study ligamentous calcifications were reported as a highly specific feature of CPPD at wrist level (1).Objectives:i) to determine the prevalence and distribution of the ultrasound (US) findings indicative of calcium pyrophosphate (CPP) crystal deposits at the wrist, with a particular focus on the dorsal aspect of the scapho-lunate ligament (SLL); ii) to investigate the diagnostic accuracy of US and conventional radiography (CR) in the evaluation of CPP crystal deposits at wrist level, iv) to assess the agreement between the different imaging techniques.Methods:Consecutive patients with a “definite” diagnosis of CPPD according to the Ryan and McCarty criteria and disease controls were prospectively included in this cross-sectional single-centre study. Dorsal part of the SLL, triangular fibrocartilage complex (TFCC), and volar recess of the radio-lunate joint were explored using US (according to EULAR standard scans and OMERACT definitions), CR and CT.Results:Sixty-one CPPD patients and 39 disease controls were enrolled. Two-hundred wrists were evaluated using both CR and US. CT data of 26 (13.0%) wrists were available: 20 wrists in CPPD patients and 6 wrists in controls. CPP crystal deposits were found by US in at least one wrist in 95.1% of CPPD patients and in 15.4% of controls (p<0.001). SLL calcification was reported in 83.6% of CPPD patients and in 5.1% of controls (p<0.001). CPP crystal deposits were observed by US at the SLL and/or radio-lunate joint in 5.7% of wrists and 6.6% of CPPD patients, but not at the TFCC of the same wrist. On CR, calcifications were found in at least one wrist in 72.1% of CPPD patients and in 0% of controls (p<0.001). Using the Ryan-McCarty criteria as a gold standard, the sensitivity, specificity and diagnostic accuracy were 0.72 (0.59-0.83), 1.0 (0.91-1.0) and 0.83 (0.74-0.90) for CR and 0.95 (0.86-0.99), 0.85 (0.69-0.94) and 0.91 (0.84-0.96) for US. Table 1 shows the agreement between the different imaging techniques.Tabel 1.Agreement between US and the other imaging techniques in the evaluation of CPP crystal deposits at the wrist.US-CR (n=200)US-CT (n=26)TFCC0.55 (0.43-0.67)0.70 (0.43-0.97)SLL0.23 (0.07-0.39)0.69 (0.41-0.97)RLJ0.25 (0.09-0.41)0.46 (0.12-0.80)Legend.n: number of the wrists,RLJ: volar recess of the radio-lunate joint. Values in brackets are the 95% confidence intervals of the Cohen’s kappa.Figure 1provides a pictorial evidence of the appearance of CPP crystal deposits in the SLL.A: CPP crystal deposits (curved arrow) at the TFCC. The SLL is not assessable due to superimposition of other bones.B: in the same patient of figure 1A, CT scan shows the presence of a calcification of the dorsal aspect of the SLL (arrow).C: dorsal longitudinal scan of the SLL: isolated hyperechoic spot (arrowheads) inside the ligament.D: dorsal longitudinal scan of the SLL showing the presence of a large aggregate extending towards the extensor tendons and hyperechoic spots (arrowheads) within it.Legend.iii: third extensor compartment,iv: fourth extensor compartment,l: lunate bone,s:scaphoid bone.Conclusion:This study supports the diagnostic accuracy of US in evaluating wrist involvement in CPPD patients. SLL calcifications are a specific US finding of CPPD at wrist level.References:[1]Ziegeler K, Diekhoff T, Hermann S, et al. Low-dose computed tomography as diagnostic tool in calcium pyrophosphate deposition disease arthropathy: focus on ligamentous calcifications of the wrist. Clin Exp Rheumatol 2019;37:826-33.Disclosure of Interests:Edoardo Cipolletta: None declared, Gianluca Smerilli: None declared, Riccardo Mashadi Mirza: None declared, Andrea Di Matteo Grant/research support from: the publication was conducted while Dr. Di Matteo was an ARTICULUM fellow, Fausto Salaffi Speakers bureau: Dr. Salaffi reports personal fees from Bristol Myers Squibb, personal fees from Pfizer, personal fees from Novartis, personal fees from AbbVie, personal fees from Roche, personal fees from Merck Sharp & Dohme Italia, outside the submitted work., Walter Grassi Speakers bureau: Prof. Grassi reports personal fees from AbbVie, personal fees from Celgene, personal fees from Grünenthal, personal fees from Pfizer, personal fees from Union Chimique Belge Pharma, outside the submitted work., Emilio Filippucci Speakers bureau: Dr. Filippucci reports personal fees from AbbVie, personal fees from Bristol-Myers Squibb, personal fees from Celgene, personal fees from Roche, personal fees from Union Chimique Belge Pharma, personal fees from Pfizer, outside the submitted work.

scholarly journals Comparison of three imaging techniques in diagnosis of chondrocalcinosis of the knees in calcium pyrophosphate deposition disease

Rheumatology ◽  
2013 ◽  
Vol 52 (6) ◽  
pp. 1090-1094 ◽  
Author(s):  
V. G. Barskova ◽  
F. M. Kudaeva ◽  
L. A. Bozhieva ◽  
A. V. Smirnov ◽  
A. V. Volkov ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Deposition Disease ◽  
Deposition Disease

scholarly journals POS1132 DIAGNOSTIC ACCURACY OF CONVENTIONAL RADIOGRAPHY OF THE KNEE FOR CALCIUM PYROPHOSPHATE DEPOSITION DISEASE: AN ANCILLARY STUDY OF THE OMERACT ULTRASOUND – CPPD GROUP

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 845-845
Author(s):  
S. Sirotti ◽  
F. Becce ◽  
L. M. Sconfienza ◽  
C. Pineda ◽  
M. Gutierrez ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Hyaline Cartilage ◽  
Conventional Radiography ◽  
Criterion Validity ◽  
Calcium Pyrophosphate ◽  
Ancillary Study ◽  
Calcium Pyrophosphate Deposition Disease ◽  
Deposition Disease

Background:Conventional Radiography (CR) has been widely used in the assessment of knee chondrocalcinosis (CC) and is still considered one of the most important diagnostic methods for the diagnosis. However, there are very few studies that examine the diagnostic accuracy of CR compared to histology of the knee tissues.Objectives:To assess the diagnostic accuracy of CR of the knee in Calcium Pyrophosphate Deposition Disease (CPPD) by using the recently created definitions for CPPD in CR of the ACR/EULAR taskforce for the new classification criteria for CPPD.Methods:This is an ancillary study of the Criterion Validity of Ultrasound in CPPD study [1]. Consecutive patients with osteoarthritis (OA) awaiting total knee replacement were enrolled in 4 centres from Romania, Italy, USA and Mexico. All patients underwent CR of the knees taken maximum 6 months before surgery, in posterior-anterior weight baring and lateral projections. DICOM files of the radiographs were anonymised and read independently by two musculoskeletal radiologists with experience in microcrystalline arthropathies. For each patient, a dichotomic score was used (absence/presence of CC) at the level of the menisci and tibiofemoral hyaline cartilage by each reader. The definitions of the ACR/EULAR taskforce for identification of CPPD in CR were used in this study [paper in preparation]. According to these definitions CPPD in CR appears as “linear or punctate opacities in the region of fibro- or hyaline articular cartilage/synovial membrane or joint capsule/within tendons or entheses that are distinct from denser, nummular radio-opaque deposits due to basic calcium phosphate deposition”. In case of disagreement a consensus decision was taken by both radiologists after discussion of the case. Menisci and the hyaline cartilage were analysed using compensated polarized light microscopy as described previously [1], patients were considered positive for CPPD if at least one of their tissue specimens revealed the presence of calcium pyrophosphate crystals. All examiners were blind to each other’s findings.Results:We enrolled 33 patients with OA (61% female, mean age 69yo). The accuracy values of CR in the various sites of the knee are indicated in Table 1. CR demonstrated to be a specific exam for identification of CPPD at the knee, but sensitivity remains low in all sites and in the overall evaluation. Identification of CPPD appears challenging and this could be due to the advanced grade of OA in our cohort of patients. Advanced degeneration, dislocation of the menisci and thinning of the hyaline cartilage in these patients is frequent and the eventual presence of calcific deposits in one of these structures could overlap with other anatomical structures making the exact localisation difficult. According to the results of the predictive values, the presence of typical deposition on CR allows a definite confirmation of the diagnosis, but a negative radiography does not exclude CPPD as testified by the low negative predictive value.Table 1.Sensitivity, specificity, PPV, NPV, accuracy and AUC of CR for identification of CPPD by using the new ACR/EULAR taskforce definitions.Medial meniscusLateral meniscusHyaline cartilageOverallSensitivity22%33%31%42%Specificity100%100%85%90%Positive predictive value100%100%67%80%Negative predictive value56%60%55%61%Accuracy61%68%58%66%AUC0.60.70.60.7Conclusion:CR has been extensively used for the diagnosis of OA and CPPD and has been tested previously for diagnostic accuracy. The results of our study confirm that the presence of typical CPPD calcifications, as defined by the ACR/EULAR task force, are highly specific but have low sensitivity for disease identification when using CR. Absence of CPPD on CR does not exclude the diagnosis.References:[1]Filippou G, et al. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis 2020. doi:10.1136/annrheumdis-2020-217998Disclosure of Interests:None declared.

Case Report: Calcium Pyrophosphate Deposition Disease of the TMJ

Skull Base ◽  
2011 ◽  
Vol 21 (S 01) ◽  
Author(s):  
Vasisht Srinivasan ◽  
Andrew Wensel ◽  
Paul Dutcher ◽  
Shawn Newlands ◽  
Mahlon Johnson ◽  
...  
Keyword(s):  
Case Report ◽  
Calcium Pyrophosphate ◽  
Calcium Pyrophosphate Deposition Disease ◽  
Deposition Disease

Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb

2021 ◽  
Vol 25 (02) ◽  
pp. 346-354
Author(s):  
Alain G. Blum ◽  
Marnix T. van Holsbeeck ◽  
Stefano Bianchi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Motor Function ◽  
Crucial Role ◽  
Imaging Techniques ◽  
Resonance Imaging ◽  
Pathologic Lesions ◽  
Essential Function

AbstractThe unique anatomical characteristics of the thumb offer a broad range of motion and the ability to oppose thumb and finger, an essential function for grasping. The motor function of the thumb and its orientation make it particularly vulnerable to trauma. Pathologic lesions encountered in this joint are varied, and imaging techniques play a crucial role in injury detection and characterization. Despite advances in diagnostic accuracy, acute thumb injuries pose a challenge for the radiologist. The complex and delicate anatomy requires meticulous and technically flawless image acquisition. Standard radiography and ultrasonography are currently the most frequently used imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations, and magnetic resonance imaging may be useful in equivocal cases. In this article, we present the relevant anatomy and imaging techniques of the thumb.

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