Knee chondrocalcinosis: An ultrasonographic study of the hyalin cartilage
Introduction
Up until now, the diagnosis of chondrocalcinosis and CPPD disease have been based mainly on radiographic or microscopic detection of the typical crystals and clinical manifestation of arthritic “pseudogout” attacks [1], [2], [3].
Crystal deposition (calcium pyrophosphate dihydrate (CPPD), basic calcium phosphate) may cause bursitis and tendinits, fever and pain nor silent cases are uncommon [4]. Other consequences such as tendon calcification may occur as well. Prospective, controlled study has shown that, for example, gastrocnemius tendon calcification is an accurate radiographic marker of chondrocalcinosis in patients with knee pain [5]. Ultrasound (US) is a versatile tool in musculoskeletal imaging. US is very sensitive in showing echogenic foci in and around the joint. Because there is only scanty information [6], [7], [8] in the literature about the importance of US in the evaluation of patients with chondrocalcinosis our target was to test this patient population in a controlled study.
Section snippets
Method
Both knees of the 21 selected patients with a history of unilateral knee chondrocalcinosis were examined in the National Institute of Rheumatology, Budapest, Hungary and in the Institute of Pulmonology of Nograd, Hungary in a controlled study.
The evaluated cohort consisted of 14 women and 7 men (mean age 55.6 years, age range 39–76 years) and the control group consisted of 19 patients older than 50 years with mild osteoarthritis and without chondrocalcinosis on radiographs (2 males, 15 females,
Results
Ultrasonically detectable calcification was present in 17 of 21 selected HC knees (Group I) and in 17 of the Group II. The later findings were confirmed on radiographs in 15. The sensitivity and specificity of Groups I and II was 80–100% and 89–91%, respectively. The overall sensitivity and specificity (combined Groups I and II) of US to detect calcification in HC proved to be 89% and 90% (Table 1). It is of interest that we observed HC posteriorly more often (26 of 32).
Popliteal cyst was
Discussion
Hyalin chondrocalcinosis and calcium pyrophosphate deposition in and around the joints are often associated with knee pain. The sensitivity of plain radiographs to detect soft tissue changes or calcification may vary though earlier studies have shown that for example musculus gastrocnemius tendon calcification is a useful marker of chondrocalcinosis and the association between chondrocalcinosis and this tendon calcification is strong. This is important because physical examination has little or
References (13)
- et al.
Prevalence and patterns of tendon calcification in patients with chondrocalcinosis of the knee: radiologic study of 156 patients
Clin Imaging
(1998) - et al.
Sonographic imaging of normal and osteoarthritic cartilage
Semin Arthritis Rheum
(1999) - et al.
Ultrasonography of the popliteal fossa and lower extremities
Radiol Clin North Am
(1988) - et al.
The wrist arthropathy of “pseudogout” occurring with and without chondrocalcinosis
Radiology
(1974) - et al.
Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease (CPPD). Pseudogout
Radiology
(1977) Crystals in arthritis: new age nonsense or novel therapeutic target
Ann Rheum Dis
(1999)
Cited by (51)
Reliability of a new scoring system for intraarticular mineralization of the knee: Boston University Calcium Knee Score (BUCKS)
2020, Osteoarthritis and CartilageComparison of ultrasonography and radiography of the wrist for diagnosis of calcium pyrophosphate deposition
2019, Revue du Rhumatisme (Edition Francaise)Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A systematic literature review and a meta-analysis
2016, Osteoarthritis and CartilageCitation Excerpt :The pooled sensitivity was 0.89 (95% CI 0.72–0.97) and specificity was 0.94 (95% CI 0.87–0.98). Considering the US performance at the level of each joint structure, the highest value of sensitivity was obtained at the hyaline cartilage4,5,10,21,35,41,43 with a pooled sensitivity of 0.77 (95% CI 0.63–0.87) and specificity of 0.92 (0.16–1.00), and at the fibrocartilage4,34,35,41,43 with a pooled sensitivity of 0.77 (95% CI 0.31–0.96) and specificity of 0.96 (95% CI 0.75–1.00), while for the tendons6,30 the sensitivity and specificity were respectively 0.34 (0.16–0.58) and 1.00 (95% CI 0.89–1.00). Another important source of heterogeneity among the studies was the type of reference standard used.
Ultrasonography in crystal-related diseases
2015, Revue du Rhumatisme Monographies