“Crystal Clear”—Sonographic Assessment of Gout and Calcium Pyrophosphate Deposition Disease
Section snippets
Materials and methods
The US pictures illustrated in this article were obtained in a cohort of 60 consecutive patients with crystal-related arthropathies (34 with CPPD disease and 26 with gout) with a diagnosis confirmed by synovial fluid analysis. The study was carried out over a 1-year period. The US examinations were performed using the following high-quality US systems: Diasus (Dynamic Imaging, Livingstone, UK) and Logiq 9 (General Electric Medical Systems, Milwaukee, WI). Both US systems were set to obtain a
Articular Cartilage
The normal sonographic appearance of articular cartilage (AC) is characterized by 2 sharply defined hyperechoic margins delimiting an anechoic and homogeneous layer. The superficial margin is typically thinner than the deeper one and is optimally visualized when the direction of the US beam is perpendicular to the cartilage surface (Fig. 1). In patients with longstanding untreated gout, MSU crystal deposition on the surface of the AC results in hyperechoic enhancement of the superficial margin,
Discussion
This pictorial essay demonstrates that both MSU and pyrophosphate crystal aggregates can be clearly depicted by US at different anatomical areas and tissues. The spectrum of US appearance of urate crystal aggregates can vary from homogeneously punctate (urate sand) to sharply defined hyperechoic densities of variable dimensions and eventually to dense tophaceous material, which is impermeable to the US beam. The conformation and anatomical location of the crystal aggregates in CPPD are the main
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