Date: Monday, October 22, 2018
Session Title: Imaging of Rheumatic Diseases Poster II: Ultrasound
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Conventional radiography (CR) and, more recently, US play a key role in the diagnosis of CPPD. To date, only a very few studies have investigated the diagnostic ability of US and CR in the assessment of hip joint in CPPD patients. To the best of our knowledge, there is no study that has compared the diagnostic accuracy of these two imaging techniques in the detection of calcium pyrophosphate (CPP) crystal deposits at the hip in patients with CPPD.
The aims of this study are to investigate the prevalence of the US findings indicative of CPP crystal deposits at the hip in patients with CPPD and to evaluate the diagnostic performance of US and CR and the agreement between these two imaging techniques in the evaluation of CPP crystal deposits at the hip in patients with CPPD.
Consecutive patients with “definite” CPPD, diagnosed according to the Ryan and McCarty criteria, and age/sex/body mass index-matched disease controls were enrolled. Inclusion criteria: knees and hips CR performed within the previous 6 months and synovial fluid analysis. Exclusion criteria: prior remarkable hip injuries, surgery procedures or severe osteoarthritis.
A rheumatologist, blinded to clinical data, performed bilateral US examinations of the hip in all patients, assessing the presence of CCP crystal deposits both at the acetabular fibrocartilage and at the hyaline cartilage of the femoral head. The OMERACT definition for the identification of CPPD by US were used. The US examination was carried out using a My Lab Twice US machine (Esaote S.p.A. Genoa, Italy), working with a linear (3-13 MHz) and, when necessary, a convex probe (2-7 MHz).
Two independent radiologists, blinded to the clinical and US findings, evaluated the presence/absence of CR calcifications at hip joints in both groups.
Forty-three patients with CPPD [age (mean±standard devation) 72.0±9.2; 24 females] and 40 controls were included in the study.
US findings indicative of CPP crystal deposits were found in at least one hip in 39 out of 43 (90.7%) patients with CPPD, in 62 out of 86 (72.1%) hips. US and CR sensitivity was 91% and 86%, respectively, whereas US and CR specificity was 85% and 90%, respectively. Sixty-nine patients were assessed using a linear probe (34 patients with CPPD, 35 controls) whereas the remaining 14 patients were studied using a convex probe (9 patients with CPPD, 5 controls).
The inter-reader agreement between the two radiologists which evaluated the CR images was k=0.77 (95%CI 0.67-0.87). The agreement between the US and CR finding was k=0.76 (95%CI 0.67-0.87).
Our results show a high prevalence of CPP crystal deposits at the hip in patients with CPPD. This study supports the role of US as a first-line safe and more sensitive imaging technique compared to CR.
- Vele P et al. Clinical and ultrasound findings in patients with calcium pyrophosphate dehydrate deposition disease. Med Ultrason. 2018 May 2;20(2): 159-163.
- Rensick D et al. Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate deposition disease (CPPD): pseudogout. Radiology 1977 Jan;122(1):1-15.
To cite this abstract in AMA style:Di Matteo A, Filippucci E, Cipolletta E, Musca A, Carotti M, Mashadi Miza R, Jesus D, Di Carlo M, Salaffi F, Grassi W. Musculoskeletal Ultrasound and Conventional Radiography Evaluation of the Hip in Patients with Calcium Pyrophosphate Deposition Disease [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/musculoskeletal-ultrasound-and-conventional-radiography-evaluation-of-the-hip-in-patients-with-calcium-pyrophosphate-deposition-disease/. Accessed January 25, 2022.
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